First Aid
Every
Emergency.
4
First Aid Manual
©4Life Pty Ltd
This work including illustrations is copyright. Apart from
any use as permitted under the Copyright Act 1968, no part
may be reproduced by any process without prior written
permission from the copyright holders. Requests and inquiries
concerning reproduction and rights should be addressed to
Suite 9, 311 Glen Osmond Road, Glenunga SA 5064.
www.4lifetraining.com.au
First published 2006
4 th Edition 2011
4Life First Aid Manual
4 th Edition.
Authors – Bruce Cameron and Melinda Asquith
Subject – First Aid Training
I
Contents
FIRST AID OVERVIEW
Introduction
2
What is First Aid?
3
Legal Considerations in First Aid
4
First Aid Kits
6
First Aid Hygiene
7
Immediate Action
8
Getting Help (Calling Emergency Services)
8
Medical Alert Devices
9
Reassuring the Casualty
10
Human Anatomy
11
The Nervous System
11
The Cardiovascular System
12
The Respiratory System
13
The Musculoskeletal System
13
The Digestive System
14
The Urinary System
14
The Endocrine System
14
The Lymphatic System
14
The Reproductive System
15
The Skin
15
WHERE TO BEGIN
II
1
17
Emergency Action Plan: DRSABCD
18
Basic Life Support Flow Chart
21
Unconscious Casualty
22
24
Breathing
27
Rescue Breathing
29
Compressions – Adult, Child, Infant
32
Defibrillation
33
Automated External Defibrillation (AED)
34
Cardiopulmonary Resuscitation
36
CPR – Adult, Child, Infant
37
Cardiac Arrest
40
The Chain of Survival
41
Assessing an Accident Scene
42
Primary Assessment
42
Secondary Assessment
43
Reassuring the Casualty
46
TRAUMA
Contents
Airway Management
47
Bleeding and Shock
48
Nose Bleed
51
Internal Bleeding
52
Shock
53
Burns
55
Airway Burns
57
Head Injuries
58
Ear Injuries
59
Eye Injuries
61
Tooth Injuries
62
Spinal Injuries
63
Helmet Removal
64
III
Chest Injuries
65
Abdominal Injuries
67
Crush Injuries
68
Fractures
69
Slings
71
Soft Tissue Injuries
73
MEDICAL
Syncope (Fainting)
76
Anaphylaxis
77
Asthma
79
Hyperventilation
81
Stroke
82
Choking
83
Febrile Convulsion
86
Diabetes
87
Seizure (Fitting)
89
Heart Conditions
90
Chest Pain
90
Angina and Heart Attack
91
Poisoning
92
Drug Overdose
94
Heat Exhaustion
96
Heatstroke
97
Hypothermia
98
Drowning
IV
75
100
101
Snakes
102
Spiders
103
Bee, Wasp and Ant Stings
105
Marine Creatures
106
ADVANCED FIRST AID
111
Triage – Prioritisation of Casualty Treatment
112
Road/Machine Accidents
113
Diving Emergencies
115
Behavioural Emergencies
118
Oxygen Administration
119
Back Care (Care of the Spine)
123
Emergency Childbirth
125
TECHNIQUES
Techniques
Contents
BITES AND STINGS – ENVENOMATION
129
130
WORKBOOK
137
INDEX
149
V
VI
First Aid Overview
FIRST AID OVERVIEW
1
Introduction
Being confronted with an
emergency situation can be
very frightening. Knowing what
to do to help the casualty in
this setting is a wonderful skill.
Imagine knowing that you are
able to change or even save
the life of your family member,
friend or workmate in an
emergency.
The 4Life First Aid Manual is
designed to assist a First Aider
by providing comprehensive
but accessible information and
strategies for many emergency
situations.
The skills required to perform
emergency First Aid are
essentially simple but it is
important to understand how
to perform them appropriately
and effectively. Prompt,
confident application of
First Aid can save lives.
This manual will assist with
First Aid training, as well as
being a useful resource. It will
also enable the retention of
practical skills and knowledge
received during the training
sessions.
The 4Life First Aid Manual adheres to all current
Australian Resuscitation Council (ARC) guidelines.
2
First Aid is the initial care and
treatment of the sick or injured
person. It is care initiated
as soon as possible after an
accident or onset of illness.
Prompt assistance and
care in the period prior to
the ambulance arrival can
significantly alter the outcome
for the person involved. It may
mean the difference between
a full or partial recovery, or
even the difference between
life and death.
The main aims of First Aid are
to:
• preserve life
• protect from further harm
• relieve pain
• promote recovery.
First Aid Overview
What is First Aid?
Cardiopulmonary ­Resuscitation
(CPR) consists of:
• r escue breathing, which
is also commonly known as
mouth-to-mouth
•e
xternal Chest Compression
(ECC).
CPR allows oxygenated blood
to circulate to vital organs such
as the brain and heart. Even if
rescue breathing is not possible
by the First Aider, it is important
to remember to apply external
chest compression (ECC) as
this will maintain oxygen to
the person’s brain until more
advanced help arrives.
In order to preserve life the
First Aider may be involved
in providing a number of
simple life-saving treatments,
including Cardiopulmonary
Resuscitation.
3
Legal Considerations in First Aid
First Aiders should be aware of
the potential legal consequences
of becoming involved in an
incident. However, State Acts
(one of which is the ‘Good
Samaritan Act’) exist to protect
volunteers and First Aiders
who are not accepting financial
gain in a formal setting.
There are four main legal
considerations which relate
to First Aid.
1. Duty Of Care
Common Law does not impose
an automatic duty on First Aiders
to render aid to a casualty.
However, if you choose to
provide First Aid assistance you
have a duty to use your knowledge
and skills in a responsible way,
to exercise reasonable care
and to act in accordance with
your level of training.
You should continue to provide
First Aid until:
• s omeone with more
qualifications than you
(e.g., paramedic, doctor,
nurse) relieves you
• another First Aider relieves you
4
• t he casualty no longer
requires First Aid
• y ou become incapable
of continuing.
A nominated workplace First
Aider has a duty of care imposed
on them by law to assist another
person in the workplace.
A duty of care can be imposed
by legislation.
2. Negligence
It is an unlikely possibility that
a First Aider may be sued in
connection with providing First
Aid. If it did occur, the likelihood
is that the Australian courts
would find liability only if the
First Aider’s behaviour was
grossly negligent.
3. Consent
Under Australian law, you
should ask for and receive
the casualty’s consent to your
treatment before you start.
If the casualty is unconscious,
or unable to give consent due
to his or her injuries, consent
may be assumed.
4. Recording
If possible, a First Aider should
immediately document the
incident, no matter how minor.
This documentation may later
be used as a form of evidence.
If you have a role as a First
Aider at your workplace, you
may have obligations under
Occupational Health and
Safety legislation.
First Aid Overview
For casualties under the age
of 18, consent from a parent
or guardian will be required.
If a parent or guardian is not
present you may proceed.
When preparing a report,
some general guidelines are
recommended:
• use pen only
• do not use correction fluid
• sign and date the record
•e
nsure your notes are
accurate, factual and are
based on observations rather
than opinions.
The information must be kept
confidential. Any disclosure
of personal information,
particularly in the work setting,
requires the written consent of
the person involved.
5
First Aid Kits
Possession of an appropriate,
well-stocked First Aid Kit is vital
in order to provide emergency
assistance. Keep a kit in your
car, at home and at work.
Workplaces must provide a
First Aid Kit under State and
Territory legislation. Check
with local authorities before
purchasing a “workplace”
First Aid Kit, as there are
specific requirements.
It is recommended that a
personal First Aid Kit should
have the following contents:
6
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
resuscitation face shield
bandaids
hand towels/cloths
tape
non-adhesive dressing
alcohol swabs
safety pins
large combine dressings
small plastic rubbish bags
crepe bandages
scissors
2 eye pads
splinter probes – tweezers
gloves (disposable)
saline eye wash solution
wound dressings
triangular bandages
bite and sting cream.
Infectious diseases are those
diseases which cause infections
to the human body. In some
cases they are transmitted by
contact or cross infection.
A First Aider can do little to
cure an infection but can do
a great deal to limit the risk of
infection by:
•a
voiding direct contact with
an infection
•a
voiding transmitting an
infection.
The following simple steps are
sufficient to prevent both the
First Aider and casualty from
infection:
•w
ash hands with soap and
water or rinse with antiseptic
solution
•w
ear gloves if available. This
places a barrier between the
First Aider and the casualty’s
body fluids. It is recommended
that gloves are worn at all
times but remember intact
skin will still provide a good
barrier for protection
First Aid Overview
First Aid Hygiene
•u
se a face shield or
resuscitation mask if available
when doing active Rescue
breathing or Cardiopulmonary
Resuscitation (CPR) –
techniques which you will
learn in this manual
•u
se clean bandages and
dressings
•w
ash hands and change
gloves between casualties
•c
lean up after treatment –
dispose of used dressings,
sharps, gloves and soiled
clothing safely and correctly.
Place used materials inside
a plastic bag, then inside a
second plastic bag, and tie
securely. Do not place the
bag in a rubbish bin. Dispose
of it at the local council or
hospital. Alternatively, give it
to paramedics to dispose of.
Wash hands again with soap
and water, even if you used
gloves.
7
Immediate Action
Quick action is vital.
Remember the following:
• remain calm, do not panic
• careful
and deliberate action
is of most benefit to the
casualty
• take control and be confident
• deliver appropriate treatment.
Getting Help
(Calling Emergency Services)
To get expert medical
assistance, call an ambulance
on 000 or 112:
•0
00 can be dialled from any
fixed or mobile telephone
•1
12 is an alternative
number to use when dialling
from a mobile phone.
It can be used when the
phone is out of signal range,
or even without having a
sim card or pin number
for the phone.
In the workplace, there may
be an internal number to call
in emergency. This should
be displayed on or near the
telephone.
8
When calling for help, there
are three things to remember:
1. state which service you need
– ambulance, police, fire
2. s tay on the line until
connected to the service
requested
3. g
ive as much information
as you can about the
emergency, including:
•e
xact location/address
•c
ity or town
•n
earest cross road or street
• landmarks, distance from
town or landmarks
• your name
•p
hone number from where
the call is being made
•w
hat has happened
• t he number and condition
of the casualties.
Some individuals may wear or
carry a medical alert device
(e.g., bracelet, necklace, wallet
card) to alert others as to the
nature of their specific medical
condition or illness (e.g.,
diabetes, allergies, asthma,
epilepsy, heart conditions).
First Aid Overview
Medical Alert Devices
Check to see if a medical
alert device is evident as the
information may be vital to
the casualty’s treatment.
A number may appear on
the back of the device.
This number will link to the
casualty’s file which will
provide further information.
9
Reassuring the Casualty
Reassurance is a very
important aspect of First Aid
treatment. The First Aider
should:
•c
omfort and reassure
the casualty. Keep him/
her informed of what is
happening. This constant
reassurance is of great
psychological value
• r emember that others
involved in the emergency
(e.g., workmates, relatives,
bystanders) may also need
reassurance. After the
incident has ended, take time
to gather everyone together.
Praise their efforts and let
them know how important
their contribution was.
Some common responses
include:
•c
rying “for no apparent
reason”
•d
ifficulty in sleeping
• inability to think clearly
or to make decisions
• f eeling of disbelief, shock,
anger
•c
onstant apathy, tiredness
• f eeling emotionally drained
•e
xcessive drinking and/or
drug use
• lack of appetite or extreme
hunger
•a
nxiety, feelings of
powerlessness
• f ear, sadness, depression
Emotional Responses
• flashbacks
An emergency can cause
unusual stress in those who
have been involved or affected
by it, including First Aiders.
•h
eadaches, stomach
problems, feeling sick.
Emotional responses can
appear immediately or
months/years later. They are
normal and expected. Every
person reacts differently.
10
Understanding what you are
feeling and taking positive
steps such as contacting a
person for counselling can help
you to cope. If the feelings
persist, seek professional help.
A basic understanding of
the human body’s anatomy
and physiology assists a
First Aider to recognise:
•w
hat is occurring within
the body and why
• t he potential outcomes of
the initial injury or event
•h
ow to best care for the
casualty.
The human body is composed
of several systems which allow
the body to function effectively.
An injury to one system can
ultimately affect many systems
or areas of the body.
First Aid Overview
Human Anatomy
The Nervous System
The Central Nervous System
is made up of the brain and
spinal cord. It is the control
centre of the body and is
extremely complex.
The brain regulates most of the
body’s functions, including the
respiratory system.
Damage to the Central Nervous
System can therefore have
significant and long lasting
effects on the rest of the body.
The Peripheral Nervous System
is made up of the nerves which
conduct messages from the
brain and spinal cord to other
parts of the body. These
messages relate to movement
and other sensations (taste,
touch, smell etc).
©4-Life
11
The Cardiovascular System
This system involves the heart,
blood vessels and blood. The
heart acts as a pump, pushing
the blood through the blood
vessels to the body’s organs
and tissues.
Arteries carry the oxygen-rich
blood from the heart to the
cells of the body.
Veins carry the blood back
to the heart, from where it is
transported to the lungs and
re-oxygenated before starting
the process again.
As well as oxygen, the blood
carries many sugars, proteins,
chemicals and other
substances to support the
various systems of the body.
Each time the heart pumps,
a pulse beat can be felt at
various locations around the
body. The easiest pulse points
to feel are the carotid (neck)
and radial (wrist) arteries.
The resting heart rate of the
average adult is between
60-100 beats per minute.
This is dependent on age,
general fitness and other
medical conditions.
12
©4-Life
This system comprises the:
•a
irway (mouth, nose) and
air passages to the lungs
• lungs, including alveoli
(the small air sacs within
the lungs).
The functions of the respiratory
system are to:
•p
rovide oxygen to the blood
• r emove the waste products
(carbon dioxide).
©4-Life
First Aid Overview
The Respiratory System
This process occurs at the
alveoli in the lungs. The oxygen
in the airways passes through
the membranes of the alveoli
and into the bloodstream, while
the carbon dioxide moves the
other way.
The Musculoskeletal
System
This system comprises the
bones, muscles, ligaments
and tendons which support
the body, protect the internal
organs and provide movement.
©4-Life
13
The Digestive System
This system includes the
oesophagus (food pipe),
stomach and intestines.
Food and drink travel to the
stomach via the oesophagus.
In the stomach the process
of digestion commences.
The food is then absorbed
into the body via the intestines.
Other organs (liver, pancreas)
also assist digestion by
helping to process the food
into the necessary chemical
substances the body requires.
The Urinary System
This system includes the
kidneys and bladder. The
function of this important
system is to flush
out waste products from
the body, thereby maintaining
a healthy state.
The Endocrine System
This system involves several
glands and organs which
secrete hormones to activate
bodily functions. An example
of this is the pancreas which
releases insulin necessary in
the control of blood glucose
(sugar) levels.
The Lymphatic System
This system provides a draining
mechanism for the body.
Lymphatic fluid is drained from
the body’s tissue, is strained in
the lymph nodes (in armpits,
neck and groin) and then
drains into the blood stream.
Most toxins (e.g., snake
venom) or infections absorbed
14
into the tissues are collected
by the lymphatic system,
which is slow moving.
It is possible to reduce the
movement of toxins into the
circulation by applying pressure
and immobilisation, as this
slows the lymphatic drainage.
The female reproductive
system consists of the:
The male reproductive system
consists of the:
•o
varies (which produce the
human egg)
• testes (which produce sperm)
•u
terus (where the fertilised
egg attaches and grows)
• v agina (the birth canal).
• penis.
The ovaries and testes are also
known as the sex glands and
are therefore linked with the
body’s endocrine system.
First Aid Overview
The Reproductive System
The Skin
This system includes skin,
hair and nails. The skin is the
body’s largest organ and its
function is to protect the body
from infection.
The skin’s fibres are elastic
and tough, so the skin can
therefore stretch without
easily tearing.
15
16
Where to begin
WHERE TO BEGIN
17
Emergency Action Plan: DRSABCD
The Emergency Action Plan
to be followed during the
treatment and care of a
casualty comprises seven steps:
• DANGER
• RESPONSE
• SEND FOR HELP
• AIRWAY
• BREATHING
• CPR
• DEFIBRILLATION
Refer to Basic Life Support
Chart on page 21.
DANGER
The ongoing safety of everyone
at the scene must be ensured.
Think of the safety of the
following:
• yourself
• bystanders
• casualties.
Take time to look for potential
dangers or hazards before you
enter an emergency situation.
Some examples of hazards are:
• fire
• smoke
• flammable materials
• gases/fumes
18
•
•
•
•
•
•
•
•
electricity
fallen power lines
risk of explosion
chemicals
unstable structures
sharp objects/metal
slippery surfaces
oncoming traffic.
Never enter an emergency
situation if it is unsafe. Do not
risk your own safety. Leave
dangerous situations to the
appropriate emergency service
personnel who have the
necessary equipment and
training to manage the hazard.
At times, some hazards
may be able to be removed
(e.g., turning off the electricity,
removing broken glass at a
motor vehicle accident).
Only move a casualty if there
is a hazard which cannot be
safely removed, such as fire
or poisonous fumes.
Remember your personal
protection and hygiene
to maintain your safety.
Dangers can include
infectious diseases.
The three levels of
consciousness are:
• f ully conscious –
alert, awake, orientated
to time and place
• s emi-conscious –
drowsy, confused
•u
nconscious –
unresponsive.
If the person responds
to the Touch and Talk
Technique:
•c
heck his/her condition
•a
sk if assistance is
required
• r ender assistance
as required
• call an ambulance 000
if the person appears
disorientated or
incoherent.
RESPONSE
To check for a response from
a person use the Touch and
Talk technique:
•g
ently put your hand on the
person’s shoulder and talk
loudly to them: “Are you
alright?”, “Can you hear me?”
Where to begin
The Touch and Talk Technique
is an effective method to
wake a sleepy person or to
get a reaction from a sick
or inebriated person. If there
is no response, the person
is considered to be
unconscious.
•d
o not shake the person
to gain a response.
SEND FOR HELP
Call an ambulance 000.
AIRWAY
A clear airway is essential.
To check if an airway is clear:
•o
pen mouth and inspect that
it is clear.
If visible material such as
vomit and/or blood is in the
airway it must be removed by
the First Aider:
• t urn the casualty onto his/her
side to assist with the
removal of the obstruction.
If the person does not
respond:
•c
all an ambulance 000
• shout for help
• check the airway.
19
CPR
•g
ive 30 chest compressions
followed by 2 rescue breaths
(100 compressions in a minute).
DEFIBRILLATION
•a
n AED (Automated External
Defibrillator) is a device that
adminsters an electric shock
through the chest wall to the
heart
• If an AED is available apply
now.
BREATHING
LOOKto see if the chest and
upper abdomen rises
LISTENfor the sound of
breathing from nose
and mouth
FEELfor movement of air
against your cheek
and place hand on
the chest and upper
abdomen to check
for the rise and fall.
If casualty is not breathing
normally. Start CPR.
If casualty is breathing and
unconscious consider recovery
position. Refer to page 22.
20
REMEMBER!
Any
resuscitation
is better than
none at all.
Where to begin
Basic Life Support Flow Chart*
AED = Automated External Defibrillator
*Source: ARC Basic Life Support Flow Chart (2011)
21
Unconscious Casualty
An unconscious casualty is
unable to safely control his/her
own airway due to relaxation
of his/her muscles. The tongue
has the potential to fall backwards across the airway,
and cause an obstruction.
Food, blood or vomit may
also obstruct the airway.
It is important that such
material be removed as
soon as possible.
The risk of airway obstruction
is increased if a breathing
but unconscious casualty
remains on his/her back.
The most effective way of
eliminating this problem is
to place the casualty into
the recovery position, on
his/her side. This will allow
for drainage of fluid from
the casualty’s airway and
for the tongue to fall away
from the airway opening.
Recovery position
22
Recovery Position Technique
The First Aider should:
•o
ffer reassurance and an
explanation to a casualty,
even if he/she is unconscious
• r emove any objects from
casualty’s pockets such as
keys/mobile phone
•k
neel next to the casualty,
align both legs straight
•p
lace the casualty’s arm
furthest from you at right
angles to his/her body
•p
lace the casualty’s nearest
arm to you across the chest
and place the back of his/her
hand against the cheek
All unconscious casualties
must be handled gently and
every effort made to avoid any
twisting or forward movement
of the head and spine.
•k
eep the casualty’s hand
pressed against the cheek and
place pressure on the upper
leg to roll him/her away from
you (and onto his/her side)
•a
lign the casualty’s upper leg
so that both the hip and knee
are bent at right angles
• t ilt the casualty’s head back
to maintain an open airway
•m
aintain close observation
of the casualty (airway,
breathing, circulation).
Where to begin
• t ake hold of the nearest
leg just above the knee, pull
it up, keeping the foot flat on
the ground
A pregnant woman should
be placed on her left side
if not restricted by injury.
This will prevent distress to
the foetus.
23
Airway Management
It is important to clear an
airway in an unconscious
casualty to prevent obstruction.
An obstruction is often caused
by the tongue falling backwards
and blocking the airway.
It can also be caused by
foreign material (such as food,
blood or vomit) obstructing
the airway.
Abnormal sounds in airway
obstruction include:
Obstruction may occur at any
point within the airway, from
the upper airways (windpipe
and voice box) to the bronchi
deep within the chest.
• a complete airway obstruction
makes no noise as no air is
moving.
Signs and Symptoms
Recognition of airway
obstruction
To determine whether or
not the casualty is breathing
normally, do the following:
•L
OOK for chest/abdominal
movement
•L
ISTEN at the casualty’s
mouth and nose for breath
sounds and abnormal noises
• FEEL at the casualty’s mouth
and nose for expired air.
24
• s noring – due to obstruction
of upper airway by the tongue
•g
urgling – due to obstruction
of upper airway by liquids
(blood, vomit)
•w
heezing – due to narrowing of
the airways deep in the chest
The First Aider must maintain
the airway for an unconscious
casualty. Airway maintenance
takes priority over any other
injury or illness.
Treatment
To maintain and clear the airway
of foreign material such as
vomit or blood, the following
is advised:
• r oll the casualty onto his/her
side
•c
arefully extend the head
backwards with your hands
• t o open airway, lift the chin
forward by placing your
fingers under bony part of
the casualty’s chin
• if the casualty has loose
fitting dentures, remove to
prevent airway obstruction.
Head Tilt
The Head Tilt Technique is used
for a casualty who is placed
on his/her side or managed on
his/her back to perform CPR.
To perform this technique:
•p
lace one hand on the
casualty’s forehead
•p
lace fingers of opposite
hand under bony part of chin
• lift the chin forward and
support the jaw, helping
to tilt the head back.
Jaw Thrust
The casualty’s airway may be
difficult to open. The jaw thrust
technique can be applied in
these circumstances.
Where to begin
• support the jaw and lift forward
to open the casualty’s mouth
To perform this technique:
•g
rasp the curve in the
casualty’s lower jaw with
both hands
• lift with both hands – this
should displace the jaw forward
• if the lower lip closes, open
with thumbs.
Assess Severity*
Ineffective Cough
Effective Cough
Severe airway
obstruction
Mild airway
obstruction
Unconscious
Call ambulance
000
Commence CPR
Conscious
Call ambulance 000
Give up to 5 back blows
if not effective
Give up to 5 chest thrusts
Encourage coughing
Continue to check
victim until recovery
or deterioration
Call ambulance 000
*Source: ARC Airway obstruction flow chart (2006).
25
AIRWAY (Adult)
A clear airway is essential
to breathe. To check that the
person’s airway is open and
clear, do the following:
• t ilt head back gently
(placing your hand on
the person’s forehead)
• s upport and lift the chin
to open airway
• t ilt the jaw forward to
open the mouth.
If a neck injury is suspected,
tilt only enough to open airway.
If the casualty’s airway is
obstructed:
• t urn the casualty onto
his/her side
• remove any visible obstruction
from the casualty’s mouth,
such as vomit or broken or
dislodged false teeth (but
leave well-fitting dentures
in place).
Once the airway is clear:
• check the casualty’s breathing.
AGE GROUPS
• Infant – Under 1 year
• Child – Between 1 year
and 8 years
• Adult – 9 years +
26
AIRWAY (Child)
To check that a child’s airway is
open and clear, do the following:
• s upport the child’s head
in horizontal position (the
child is on his/her back)
•o
pen mouth
• look inside
•c
lear the airway of foreign
materials
•d
o not bend the head back
– this will block the airway.
Instead, place the child on
his/her back and with careful
movement slightly tilt back
the head.
AIRWAY (Infant)
To check that an infant’s
airway is open and clear,
do the following:
• s upport head in horizontal
position (the infant is on
his/her back)
•o
pen mouth
• look inside
•c
lear the airway of foreign
materials
• do not bend the head back
– this will occlude (block) the
airway. Instead, place the
infant in the neutral position
(that is, how the infant would
normally lie on his/her back).
BREATHING (Adult)
BREATHING (Child)
Keep the airway open and
check for normal, effective
breathing by using the Look,
Listen and Feel method,
as follows:
Keep the airway open and
check for normal, effective
breathing by using the Look,
Listen and Feel method,
as follows:
•L
OOK to see if the chest
and upper abdomen rises
and falls
•L
OOK to see if the chest
and upper abdomen rises
and falls
•L
ISTEN for the sound of
breathing from nose and
mouth
• LISTEN for the sound of
breathing from nose and
mouth
•F
EEL for the rise of the chest
and upper abdomen under
your hand and for air against
your cheek.
•F
EEL for the rise of the chest
and upper abdomen under
your hand and for air against
your cheek.
If breathing normally:
• t urn the casualty to
the Recovery Position
(on his/her side)
•c
all an ambulance 000
•c
ontinue to monitor the
casualty’s condition.
If breathing normally:
• t urn the child to the
Recovery Position
(on his/her side)
•c
all an ambulance 000
•c
ontinue to monitor the
child’s condition.
If not breathing normally:
•c
all an ambulance 000
• s tart CPR (Refer to page 36
for details of CPR).
If not breathing normally:
•c
all an ambulance 000
• s tart CPR (Refer to page 36
for details of CPR).
Where to begin
Breathing
27
BREATHING (Infant)
Keep the airway open and
check for normal, effective
breathing by using the Look,
Listen and Feel method,
as follows:
•L
OOK to see if the chest
and upper abdomen rises
and falls
•L
ISTEN for the sound of
breathing from nose and
mouth
•F
EEL for the rise of the chest
and upper abdomen under
your hand and for air against
your cheek.
28
If breathing normally:
• t urn the infant to the
Recovery Position
(on his/her side)
•c
all an ambulance 000
•c
ontinue to monitor the
casualty’s condition.
If not breathing normally:
•c
all an ambulance 000
• s tart CPR (Refer to page 36
for details of CPR).
When you are performing rescue
breathing you are actually
breathing oxygen into the
casualty’s lungs. Your exhaled
breath contains 16% oxygen
which is close to the 20%
contained in the air you
breathe in.
Rescue breathing is essential
to provide oxygenation of the
casualty’s brain, which will
hopefully prevent brain
damage and eventual death.
Mouth-to-Mouth
To perform mouth-to-mouth
resuscitation:
•g
ently tilt head back
•p
inch the nostrils closed with
thumb and index finger or
seal nose with your cheek
•p
lace your mouth tightly
over the casualty’s mouth
•b
low 2 quick breaths and
observe for rise and fall of
the casualty’s chest.
Mouth-to-Nose
If the casualty has suffered an
injury to the mouth, or there
is some other reason why
mouth-to-mouth resuscitation
is impossible, you may need to
ventilate through the nose:
Where to begin
Rescue Breathing
• gently tilt head back
•c
over the casualty’s mouth
firmly and close your mouth
around the nose, forming a
tight seal
•b
low 2 breaths gently into
casualty’s nose
•o
pen the casualty’s mouth
to allow air to escape as
the chest falls. Cover again
to blow into the nose,
just enough to make the
chest rise.
Mouth-to-Mouth-and-Nose
When an infant or small child is
unconscious and not breathing
normally, rescue breathing can
be done through the nose and
mouth:
•m
aintain the infant’s head
in a neutral position (avoid
excessive head tilt) and
ensure the airway is clear
29
• s eal your lips around the
infant’s mouth and nose and
breathe until the chest rises
• r emove your mouth and,
as the chest falls, allow the
infant to exhale.
Slow gentle breaths are
required for a young child or
infant. The preferred technique
is to puff breath from the
First Aider’s mouth. This will
prevent over-inflation of the
infant’s lungs.
Mouth-to-Mask
Mouth-to-Stoma
• gently tilt head back
In some instances, a casualty
may breathe through an
opening in the front of his/her
neck called a stoma. This is
due to surgery and having part
of his/her trachea removed.
To perform mouth to stoma
resuscitation:
• fi
t mask firmly over casualty’s
mouth and nose
•p
lace mouth over stoma and
tightly seal (there is no need
to cover mouth and nose)
•d
o not tilt head back too far
as this may block the airway
•b
reathe as for mouthto-mouth
30
• if the casualty’s chest does
not rise, you should cover
his or her mouth and nose
and continue breathing
through the stoma.
The most desirable form of
rescue breathing is by mouthto-mask. It will help reduce
the risk of cross infection and
protect the First Aider from
exposure to casualty’s body
fluids. To perform:
•d
eliver rescue breaths via a
valve or tube at top of mask
•b
low 2 gentle breaths and
observe for rise and fall of
the casualty’s chest.
• t he casualty is not breathing
normally
• t he casualty’s skin is blue
in colour.
How to Perform
Rescue Breathing
AIRWAY
•o
pen the casualty’s airway
by tilting his/her head back
with one hand while lifting up
his/her chin with your other
hand. Check that it is clear
Where to begin
When to Perform
Rescue Breathing
• if the airway is obstructed,
roll the casualty onto his/
her side and clear the
obstruction.
DANGER
•e
nsure the safety of
yourself and others; check
for potential dangers and
hazards.
RESPONSE
BREATHING
•c
heck breathing – Look,
Listen and Feel for breathing
• if the casualty is not
breathing normally, start CPR.
•p
lace the casualty flat on his/
her back on a hard surface
• t ouch the casualty on the
shoulder. Ask in a loud voice,
“Are you okay?”
• if no response, call an
ambulance 000.
SEND FOR HELP
Call an ambulance 000.
31
Compressions –
Adult, Child, Infant
EXTERNAL CHEST COMPRESSIONS
(Adult)
•p
lace heel of one hand on centre of casualty’s
chest. With your other hand directly on top of first
hand, depress sternum 1/3 depth of the chest
•p
erform 30 compressions to every 2 breaths
(rate: 100 per minute).
EXTERNAL CHEST COMPRESSIONS
(Child)
•p
lace heel of one hand on centre of casualty’s
chest. With your other hand directly on top of first
hand, depress sternum 1/3 depth of the chest
•p
erform 30 compressions to every 2 breaths
(rate: 100 per minute).
EXTERNAL CHEST COMPRESSIONS
(Infant)
•p
lace 2 fingers of one hand on centre of
infant’s chest
•c
ompress chest 1/3 depth of the chest
•p
erform 30 compressions to every 2 breaths
(rate: 100 per minute).
REMEMBER!
Any resuscitation is better than
none at all.
32
An AED (Automated External
Defibrillator) is a device that
administers an electric shock
through the chest wall to the
heart:
• if an AED is available apply
now.
Where to begin
Defibrillation
If you see this sign, this is where a defibrillator is located.
33
Defibrillation
Automated External Defibrillation (AED)
A Heart Attack can interfere
with the heart’s rhythm and
ability to pump. Instead of
the heart beating normally,
the rhythm can be chaotic
(ventricular fibrillation) or stop
the heart altogether. When
this happens it is known
as a cardiac arrest.
When a person experiences
cardiac arrest, CPR will help
keep oxygen flowing to the brain,
but the electric shock from
an AED vastly improves the
chances of restarting the heart.
34
What is An AED?
An AED is a device that
administers an electric shock
through the chest wall to the
heart. The AED assesses the
person’s heart rhythm. It
determines whether defibrillation
is required and then administers
the necessary level of shock by
the user pressing the
appropriate buttons. Audible
and/or visual prompts will step
the user through the process.
The following is the process
which is undertaken when
using an AED:
If Shock is Indicated
•e
nsure that everybody is
clear of the casualty
• in a loud voice say, “stand
clear”
Where to begin
First Aiders can be trained to
use an AED. Most AEDs are
designed to be used by people
without medical backgrounds.
AEDs are most effective when
appropriate training programs
are in place.
•w
hen directed by AED push
shock button
• r epeat or “shock” as directed
by AED.
• s witch on defibrillator
•a
ttach the electrode pads
to casualty as directed by
diagram on pad
• f ollow spoken/visual
directions
•e
nsure that nobody touches
the person whilst the AED is
analysing the rhythm.
Caution
When using an AED remember
the following:
• always
turn off and remove
oxygen that the casualty may
be using
• make
sure the area is dry
around the casualty
• the
AED should be used by
trained personnel
• maintain
safety standards
• never
connect the AED to
anyone who is conscious
• never
use near explosive
materials.
35
Cardiopulmonary Resuscitation
Cardiopulmonary Resuscitation
(CPR) consists of external
chest compression (ECC) and
rescue breathing. CPR allows
oxygenated blood to circulate
to vital organs such as the brain
and heart. CPR can maintain
oxygen to the person’s brain until
more advanced help arrives.
•a
llow the chest to rise after
each compression.
When to Start CPR
Hand Positioning for Infants
A First Aider should commence
CPR when a casualty:
The First Aider should:
• is not breathing normally.
•u
se 2 fingers to perform
chest compressions
• fi
nd the centre of the chest
Hand Positioning for
Adults and Children
•p
ush down approximately
1/3 the depth of the chest
The First Aider should:
•k
eep hand and fingers clear
of the abdomen
•k
neel at the casualty’s side
•p
lace heel of one hand
on the centre of the chest
•p
lace other hand on top
interlock the fingers of
both hands
• with elbows straight push down
to a depth of 1/3 of chest
•c
ompress at a rate of
100 times per minute
36
•c
ompress at a rate of
100 times per minute
•a
llow the chest to rise after
each compression.
DANGER
AIRWAY
•e
nsure the safety of
yourself and others; check
for potential dangers and
hazards.
•o
pen the casualty’s airway by
tilting his/her head back with
one hand while lifting up his/
her chin with other hand
•c
heck that it is clear
•p
lace the casualty flat on his/
her back on a hard surface
• if the airway is obstructed,
roll the casualty onto side
and clear.
• t ouch the casualty and ask in
a loud voice, “Are you okay?”
BREATHING
SEND FOR HELP
•c
heck breathing – Look,
Listen and Feel for breathing
RESPONSE
Call an ambulance 000.
Where to begin
CPR – Adult, Child, Infant
• if casualty is not breathing
normally, start CPR.
37
CPR
(Adult and Child)
CPR
(Infant up to 1 year old)
Give 30 chest compressions
followed by 2 rescue breaths
(100 compressions in a minute).
Give 30 chest compressions
followed by 2 rescue breaths
(100 compressions in a minute).
• stop compressions if
casualty commences
breathing normally.
•p
lace two fingers in the
centre of the chest
•p
ush down 1/3 the depth
of the chest
• perform 30 compressions
to every 2 breaths
(rate: 100 times per minute)
• stop compressions if
casualty commences
breathing normally.
38
DEFIBRILLATION
Whether performing 1 or
2 person CPR, you should
stop:
An AED (Automated External
Defibrillator) is a device that
administers an electric shock
through the chest wall to the
heart:
• if the scene becomes unsafe
•o
n arrival of qualified help
•a
nother First Aider takes over
• if an AED is available apply
now.
Where to begin
When to Stop CPR
• y ou are physically unable
to continue
• casualty commences
breathing normally.
39
Cardiac Arrest
Instead of the heart beating
normally, the rhythm can be
chaotic (ventricular fibrillation)
or the heart can stop
altogether. When either of the
above happens it is known
as a cardiac arrest.
Signs and Symptoms
• t he casualty is unconscious
• t he casualty has no normal
breaths but may appear to
gasp on occasions
• t he casualty has a short
period of jerky body
movement.
40
Treatment
This is an extreme medical
emergency. Without immediate
help the person will die. The
First Aider should proceed as
follows:
• DRSABCD
• call an ambulance 000
• commence immediate CPR.
Chain Of Survival is a term
used to describe the fourstage approach for a response
to an emergency situation such
as cardiac arrest. The survival
Call
of a casualty from cardiac
arrest can significantly improve
when all four links of the Chain
of Survival are strong.
CPR
The four Links in the Chain
of Survival are:
1st Link –
Early Access
Call fast (000). Get emergency
medical help quickly to the
cardiac arrest casualty.
2nd Link –
Early CPR
Early CPR helps circulate
blood that contains oxygen
to the vital organs. This buys
time, which can be life-saving.
Where to begin
The Chain Of Survival
Defib Ambulance
3rd Link –
Early Defibrillation
Most victims of sudden cardiac
arrest need an electric shock
called defibrillation to restore
the heart to a regular rhythm.
4th Link –
Early ACLS (Early Advanced
Care Life Support)
This is given by trained
medical personnel such as
Paramedics who provide
further care.
41
Assessing an Accident Scene
Approaching a scene
On approaching a scene the
first priority is your own safety.
Before approaching, make sure
the scene is safe for yourself,
bystanders and the casualty.
Once the scene is safe you
should note the following:
• t he number of casualties
• t he possibility for assistance
from bystanders
•w
hat has actually occurred
(e.g., car accident, house fire
or heart attack).
Primary Assessment
42
The aim of the primary
assessment is to detect
serious and immediate lifethreatening injuries. The
primary assessment is a
systematic approach of
assessing and treating a
casualty. It can be applied
to both medical and traumarelated emergencies.
Unconscious
Once you have gained access
to the casualty, check to
see if he/she is conscious
or unconscious.
• call an ambulance 000.
If the casualty is unconscious:
•c
heck that the airway is clear
(If not, clear the airway)
•c
heck for normal breathing
•c
heck for any haemorrhage.
If present, control with direct
pressure over wound
• “Can you take a deep breath?”
Do not delay urgent treatment
in order to gain a detailed
history from the casualty. This
history can be obtained later or,
if possible, have a bystander
speak to witnesses or relatives
to gain vital information.
• “ Can you cough?”
Start with open ended
questions, such as:
• “ Can you describe what
happened?”
• “ Where is the pain?”
Simple questions will enable the
First Aider to gather important
information quickly. It will also
give a good indication of what
the casualty may be suffering
from. The information gained
by the First Aider is also very
important once the casualty has
been transferred to hospital.
Your history-taking and
observations may be crucial in
the treatment of the casualty.
Where to begin
Conscious
Secondary Assessment
A secondary assessment is
conducted following the primary
assessment. The secondary
assessment involves:
• make sure you are able to see
the skin when examining the
casualty. Take special care when
checking the body and limbs:
•h
istory-gathering, to
determine any medical and/or
trauma-related problems that
a casualty may be suffering
• ask the casualty if you may
look under or remove clothing
•a
systematic head to toe
examination of a casualty.
• if possible, have another
person present
The head-to-toe examination
should be systematic and
thorough so that no injuries
are missed:
•b
e careful not to unnecessarily
move the casualty while
performing the secondary
survey as movement may
cause further injury.
•e
xplain to the casualty why
this is necessary
43
HEAD
SHOULDERS AND CHEST
Look at and feel the casualty’s
head and face. Look for the
following:
Look at and feel the casualty’s
shoulders, collarbone and
chest for the following:
• abrasions
• tenderness when touching ribs
• bruising
• bruising
• fluids in the nose or ears
• swelling
• damage to the eyes.
•c
heck for unequal rise and fall
of chest during respirations.
NECK
Look at and feel the casualty’s
neck for the following:
• tenderness
• bruising
• deformity
• bleeding.
Check for Medical Alert
necklace/bracelet.
ABDOMEN AND PELVIS
Look at and feel the casualty’s
abdomen and pelvis for the
following:
• tenderness
• bruising
• swelling
• rigidity
• wounds
• press on both of the protruding
bones in the pelvis and note if
there is any pain or deformity.
44
BACK AND SPINE
Look at and feel the casualty’s
arms and legs for the
following:
Look at and feel the casualty’s
back and spine for the
following:
• bruising
• bruising
• deformity
• deformity
• haemorrhage
• haemorrhage
• pain and tenderness
• pain and tenderness.
• sensation in all limbs
To perform an examination
of the back and spine, slide
your hand carefully under the
casualty.
• check the pulse in both wrists
•c
heck the pulse at the top of
each foot
Where to begin
ARMS AND LEGS
•c
heck for full range of
movement.
Check for Medical Alert
bracelet/necklace
45
Reassuring the Casualty
Reassurance is a very
important aspect of First Aid
treatment. The First Aider should:
•c
omfort and reassure the
casualty
•k
eep him/her informed of
what is happening
• t his constant reassurance is
of great psychological value
• r emember that others
involved in the emergency
(e.g., workmates, relatives,
bystanders) may also need
reassurance
•a
fter the incident has ended,
take time to gather everyone
together
•p
raise everybody’s efforts and
let them know how important
their contribution was.
Emotional Responses
An emergency can cause
unusual stress in those who
have been involved or affected
by it, including First Aiders.
Emotional responses can
appear immediately or months/
46
years later. They are normal
and expected. Every person
reacts differently. Some
common responses include:
•c
rying for no apparent reason
•d
ifficulty sleeping
• inability to think clearly or to
make decisions
• f eeling of disbelief, shock,
anger
•c
onstant apathy, tiredness
• feeling emotionally drained
•e
xcessive drinking and/or
drug use
• lack of appetite or extreme
hunger
•a
nxiety, feelings of
powerlessness
• f ear, sadness, depression
• flashbacks
•h
eadaches, stomach
problems, feeling sick.
Understanding what you are
feeling and taking positive
steps can help you to cope.
If the feelings persist, seek
professional help.
Trauma
TRAUMA
47
Bleeding and Shock
The average adult body
contains between five and
seven litres of blood, which
circulates around the body
in order to keep the organs
supplied with oxygen.
Blood is composed of:
• r ed blood cells, which carry
oxygen and waste products
•w
hite blood cells, which
fight infection
•p
latelets, which assist in the
clotting process
•p
lasma, the liquid which
supports all these cells.
Some indicators of external
bleeding include:
• it is obvious and apparent
• it is caused by cutting,
perforating or tearing of
the skin
• s erious wounds involve
damage to blood vessels
• t he severity depends on the
type of wound and which
blood vessels are damaged.
Arteries
Blood moves around the body
under pressure through the heart
and blood vessels. If either the
blood volume or pressure is
inadequate the body’s functions
soon begin to fail.
Arteries carry blood rich with
oxygen away from the heart.
The blood can spurt with each
heart beat and is bright red in
colour.
Bleeding or haemorrhage
causes both the volume and
the pressure to decrease
through loss of blood through
the system, and therefore poses
a great threat to survival. It is
one of the most common
causes of death in accidents.
Veins
There are two types of
bleeding: external and internal.
48
External Bleeding
Blood from veins is dark red
and flows from the wound.
Capillaries
Blood from capillaries is dark
red in colour and oozes from
the wound which is usually
close to the skin.
No Embedded Object
Types of wounds which
can cause external bleeding
include:
•a
pply direct pressure with
sterile or clean pad
•g
raze – abrasion of skin
• incision – a wound made by
slicing (e.g., sharp knife/
piece of metal) which can
bleed extensively
• laceration – deep wound with
tissue loss
•a
mputation – severed body
part (e.g., a limb)
•p
uncture/embedded object
(e.g., bullet/knife wound).
Trauma
Types of Wounds
• lie the casualty down
•e
levate and support the
injured part (if possible,
above the level of the heart)
•a
pply firm bandage to hold
pad in place
• If bleeding does not stop,
remove bandage and apply
firm pressure to the wound
• t reat for shock if required
(Refer to page 53)
•c
heck circulation regularly.
Management of
External Bleeding
When treating life-threatening
bleeding, the First Aider should
do the following:
• DRSABCD
•c
all an ambulance 000
as soon as possible
•e
xpose the wound and
check for visible embedded
object (do not remove the
embedded object).
49
Embedded Object/Puncture
Wound:
Incisions/Lacerations:
• DRSABCD
•c
all an ambulance 000
•c
all an ambulance 000
•c
heck wound for foreign
matters
•c
heck wound but do not
remove any embedded object
•a
pply indirect pressure
around the wound
• s tabilise with ring pad and
non-stick dressing
• DRSABCD
•a
pply pressure – bring sides
of wound together
•a
pply a non-stick dressing
and bandage
• immobilise and elevate.
•a
pply a firm bandage
•e
levate the injured limb and
immobilise.
Amputation:
• DRSABCD
•c
all an ambulance 000
Treatment
Abrasions/Grazes:
•a
pply direct pressure to
reduce the bleeding
• DRSABCD
• check wound
•a
pply large pad or dressing
to wound
• s wab with antiseptic solution
or sterile water
• t reat for shock (Refer to
page 53)
• apply non-stick dressing.
• if possible, immobilise and
elevate injured limb
•c
ollect amputated body part
and seal in a plastic bag.
Do not wash or clean it
•p
lace amputated body part
in iced water
• f reezing will kill tissue so
do not allow the body part
to directly contact ice.
50
Treatment
Treat a nose bleed in the
following way:
Trauma
Nose Bleed
•h
ave the casualty lean
slightly forward and pinch
the fleshy part of the nose
just below the bone
•m
aintain this position for
at least 10 minutes.
Warm weather or exercise may
mean that up to 20 minutes or
more may be required to cease
the bleeding.
However:
• if bleeding persists, obtain
medical assistance
•a
dvise the casualty not
to blow or pick nose for
several hours.
51
Internal Bleeding
Internal bleeding is often
difficult to detect, as there
may be no direct evidence
of the bleeding. A thorough
history of the incident or
illness is vital to give the First
Aider the necessary clue as to
whether internal bleeding is a
possibility
Treatment and Care
Some visible indicators of
internal bleeding include:
• if the casualty is
unconscious, place him/her
in recovery position
• obvious blood loss
• s igns of shock (pale, cool,
clammy skin).
52
• DRSABCD
•c
all an ambulance 000
• rest and reassurance
• if the casualty is conscious,
position him/her supine
(face up) with legs raised
•g
ive nothing by mouth.
Shock is a life-threatening
condition. It occurs when the
body’s blood circulation is
inadequate to meet the oxygen
demands of the major organs
of the body.
Shock is a deteriorating
condition which requires active
treatment, as the casualty may
rapidly progress to a state of
total body shutdown. A delay
of even a few minutes may
lead to death, so prompt care
is vital.
Normal
Common Causes of Shock
• loss of blood
Trauma
Shock
• loss of body fluids
(e.g., due to extensive burns,
dehydration, severe vomiting
and diarrhoea)
•h
eart attack
•a
naphylaxis (severe allergic
reaction)
• s epsis (severe infection).
Signs of Shock
Skin
Pink, Warm and Dry
Pale, Cold and
Clammy
Conscious Level
Alert and Orientated
Confused, drowsy,
aggressive
53
Signs and Symptoms
Treatment and Care
A casualty suffering from
shock may display the
following symptoms:
• DRSABCD
•pale, cool, clammy skin
• r apid, shallow breathing
• r apid, weak pulse
•c
asualty is irritable or
confused
• nausea/vomiting
•c
asualty is collapsed/
unconscious.
54
•c
all an ambulance 000
•c
ontrol any bleeding
• r est and reassurance
•m
aintain the casualty’s body
temperature by covering
with a blanket
• if the casualty is conscious,
position him/her supine
(face up) with legs elevated
• if the casualty is unconscious,
place him/her in recovery
position.
Burns can be a minor
problem or a life-threatening
emergency. Distinguishing
a minor burn from a more
serious burn may be difficult
and involves determining
the degree of damage to the
casualty’s skin and tissues.
Causes
The causes of burns are
various and can include the
following:
• fire
• sun
• chemicals
Partial thickness
(second-degree) burns:
Trauma
Burns
• t he first and second layers of
the casualty’s skin are affected
• t he skin is red and blistered
• s evere pain and swelling
may occur.
Full thickness (third-degree)
burns:
•a
ll layers of the casualty’s
skin are affected
• t here is charring or whitening
of the skin
•d
ue to nerve damage, the
casualty may feel no pain
at all.
• heated objects
• fluids
• electricity.
Treatment
When treating a burn the First
Aider should do the following:
Signs and Symptoms
• DRSABCD
Superficial (first-degree) burns:
•c
all an ambulance 000
•o
nly the outer layer of the
casualty’s skin is affected
• if the casualty’s skin is not
broken, run cool water over
the burn for 20 minutes.
Do not use ice
• t he skin is usually red
• s evere pain and swelling
may occur.
•c
over the burn with a sterile
bandage or non stick clean
cloth
55
•p
lastic wrap is a commonly
used dressing for burns
•d
o not apply lotions, creams
or powder
• r emove clothing that has not
adhered to casualty’s skin
• r emove any constrictive
clothing and jewellery
•d
o not break blisters
• fl
ush skin of any chemicals
that may cause burning.
Note: if a chemical gets into
the casualty’s eyes, flush
them with water immediately.
Continue to flush the eyes
with running water for at
least 20 to 30 minutes.
All infants or children with burns
should be medically assessed.
56
This can be due to smoke and
heat from a fire, which can
cause swelling. This swelling
can lead to a life-threatening
condition due to airway
obstruction.
Treatment
• DRSABCD
Trauma
Airway Burns
• call an Ambulance 000.
Signs and Symptoms
A casualty suffering from an
airway burn may display the
following symptoms:
• f acial hair loss
• s oot around nose and mouth
•c
oughing, hoarse voice/
casualty unable to talk
•d
ifficulty breathing.
Serious burns that need
immediate emergency attention
include those which affect the
airways and cause breathing
difficulty.
57
Head Injuries
The main concern with a head
injury is that there may be
bleeding or swelling inside the
skull. This can occur even if
the skull does not appear
damaged. Blood and/or swelling
that collects within the skull may
eventually put pressure on the
brain and cause serious brain
damage.
Head injuries may be classified
as:
1. O
pen Head Injury – head
injury accompanied by an
open head wound.
2. C
losed Head Injury – there
is no obvious sign of injury
present.
Signs and Symptoms
• unconsciousness
•p
ain at the site of injury
•d
eformity of the skull
•blood or straw-coloured fluid
draining from the ears or nose
•c
hange in the level of
consciousness (the person
gets progressively sleepier)
•a
gitation and combativeness
•n
ausea and vomiting
•b
ruising around the eyes
and ears after the injury
•p
oor memory.
58
Treatment
• DRSABCD
•c
all an ambulance 000
• treat and control haemorrhage
•c
over wound with dressing
• r est the casualty and watch
closely
• if the casualty has an altered
level of consciousness and
you are concerned about
airway obstruction, place in
the recovery position making
sure the head and neck are
kept in alignment
•c
over ear with sterile pad.
If you suspect a head injury in
a person, or he/she has been
knocked unconscious, seek
medical advice immediately.
Occasionally foreign bodies
or insects lodge in the ear
canal. This may lead to an ear
infection or a far more serious
injury such as a ruptured ear
drum.
Signs and Symptoms
A casualty suffering from an
ear injury may display the
following symptoms:
•h
olding the affected ear
lower than the non-affected
side
• r edness visible in the ear
canal
Treatment
Object in Ear
Trauma
Ear Injuries
•c
alm and reassure the
casualty
• if the object is sticking out
gently remove it by hand or
with a pair of tweezers
• if you think a small object
may be lodged within the ear
but you cannot see it, do not
reach into the ear canal with
tweezers. You may do more
harm than good
• t ry using gravity to remove
object
• t ilt head to affected side
• t he First Aider can see a
possible foreign body in
the casualty’s ear
• s hake it gently towards the
direction of the ground to
hopefully dislodge the object
• s mell or discharge from ear.
• if the object does not come
out, seek medical help.
59
Insect in Ear
Ruptured Ear Drum
• do not let the casualty place
finger in the ear as may cause
the insect to go further in
If the casualty has a ruptured
ear drum he/she will experience
severe pain. The First Aider
should:
• t urn the casualty’s head so
the affected side is facing up
• t he insect may then crawl
to the top of the ear
•p
ouring a small amount of
olive oil or baby oil into the
ear may float the insect out
• seek medical advice.
60
•p
lace sterile pad over ear
• if casualty has drainage from
ear then lie the casualty with
the affected ear down to
allow drainage to occur
• s eek medical help.
An eye injury can be serious
and difficult to manage. It may
lead to permanent damage.
Seek medical help if concerned.
Signs and Symptoms
• s quinting and/or spasm of
the eyelids
• rubbing of the eye
Foreign Bodies
• flush the eye with disposable
eyewash or clean running
water for a short period of time
• if flushing does not remove
the object it may be possible
to remove it from the eye with
a well-moistened surgical
spear on an applicator stick
• redness of the eye.
• if the foreign body cannot be
removed, pad the eye and
seek medical assistance.
Treatment
Embedded Objects
Chemical Injuries
•c
all an ambulance 000
•c
all an ambulance 000
•d
o not attempt to remove
the object
• discharge, watery eye
• fl
ush the eye for at least 20
minutes, including under the
eyelids. It may be necessary
to hold the eyelids apart
Trauma
Eye Injuries
• r eassure the casualty
• assist the casualty to rest in
the most comfortable position.
• lightly pad the injured eye.
Chemical Burn to Eye
•c
all an ambulance 000
• fl
ush with cold water
for 20 minutes
• lightly pad the affected eye.
61
Tooth Injuries
A permanent tooth can often
be saved if prompt action is
taken and the tooth is handled
carefully. A permanent tooth
has the best chance of survival
if replaced within 30 minutes.
Treatment
If a casualty loses a tooth
the First Aider should do the
following:
•h
old the tooth by the crown
(the top) not the root
62
• r inse the tooth immediately
•d
o not scrub the tooth
• t he best place to preserve the
tooth is back in the socket
• r eplace it gently then have
the casualty bite down on a
gauze pad to keep it in place
• if replacing the tooth is
not possible, place the tooth
in milk
• s ee a dentist immediately.
The spinal cord, along with the
brain, makes up the central
nervous system. It is vital to be
very cautious when handling a
casualty you suspect has a
spinal injury in order to avoid
cord damage.
The spine is made up of the
vertebrae, the spinal cord, the
intervertebral discs and the
tendons, muscles and ligaments
that hold all of this together.
When the spine is injured,
vertebrae may fracture or a disc
may rupture and the spinal cord
can be severely damaged.
Sometimes, however, the cord
is uninjured. Therefore, how you
manage the casualty is very
important.
Signs and Symptoms
•h
istory of trauma
(e.g., diving, fall)
Trauma
Spinal Injuries
•u
nnatural positioning of the
body
•c
omplaint of tingling in
fingers
•n
o feeling in limbs
•u
nable to move arms and
or legs.
©4-Life
63
Treatment
other life-threatening injury
• DRSABCD
• t reat the casualty for shock
•c
all an ambulance 000
•m
aintain the casualty’s head
in alignment with his/her
shoulders
•p
erform examination of the
casualty with extreme caution
• r estrict any movement of the
casualty to a minimum to
avoid further injury
• t reat haemorrhage or any
• if the casualty requires to
be placed in the recovery
position, obtain help and
do so with the Log Roll
Technique as pictured.
Log Roll
Helmet Removal
Leaving the helmet in place
keeps the neck from bending
back too far. Helmets also fit
snugly and cradle the head,
minimising head and neck
motion.
Thus, if an injured casualty is
breathing and does not require
airway management, the
helmet should be left on to help
support the head and neck.
64
However, if a casualty requires
airway intervention, immediately
remove the helmet.
In most situations, the First
Aider should not remove the
helmet unless they cannot
establish an airway which
allows for effective breathing
or unless the helmet is not
adequately stabilising the
casualty’s head.
Injuries to the chest can
range from mild (with minimal
discomfort) to life-threatening.
Major injuries to the chest may
lead to collapse of breathing
or circulation due to damage
to the heart or lungs. The First
Aider must be aware for the
signs of shock.
Penetrating Chest Wound
A chest injury may involve the
ribs and/or lungs.
• t here is a stick or other
foreign object protruding
from the chest area.
Signs and Symptoms
• pale, cool, clammy skin
• rapid weak pulse
• rapid shallow breathing
A penetrating chest wound
can be rapidly life-threatening.
A First Aider should suspect
a penetrating chest wound if:
Trauma
Chest Injuries
• t here is a wound on the
chest and the casualty is
in respiratory distress
Do not remove foreign object
protruding from chest wall.
If the object is too large to
move the casualty, call for
emergency help. Do not cut
the object yourself.
• increased pain
• pain on touching affected area
Signs and Symptoms
•g
uarding of the affected area
•p
ale, cool, clammy skin
• bruising, swelling.
• r apid weak pulse
• r apid shallow breathing
Treatment
•p
ain at site of injury
• DRSABCD
• v isible open chest wound
•c
all an ambulance 000
• v isible object still in place.
•w
atch closely for breathing
difficulties
•g
ive oxygen if available.
65
Treatment
• DRSABCD
•c
all an ambulance 000
• if foreign object still in place,
support object with padding
around wound and tape in
position
• if the chest wound is open,
apply a non-adherent
dressing to site. Tape on
3 sides only to allow for
air or fluid to escape
•p
lace casualty in a position
of comfort
•w
atch closely for breathing
difficulties.
66
Injuries to the abdomen can
damage the internal organs
such as the liver, spleen,
kidneys or intestinal tract. The
majority of abdominal injuries
are caused by blunt trauma
through motor vehicle accidents.
Penetrating trauma is caused
by such events as stab wounds
or gunshot. Bleeding can be
profuse and life-threatening.
The First Aider must be aware
for the signs of shock.
Signs and Symptoms
•p
ale, cool, clammy skin
• r apid weak pulse
• r apid shallow breathing
•p
ain on touching abdominal
area
•g
uarding of the abdomen
• r igid abdominal area
• v omiting of blood
•b
ruising, swelling.
Treatment
• DRSABCD
Trauma
Abdominal Injuries
•c
all an ambulance 000
•g
ive nothing to drink or eat
• if the object is embedded,
do not remove but stabilise
by applying padding
• if possible, and if the casualty
is conscious, carefully place
the casualty onto his/her back
• r aise the casualty’s legs to
help with shock process
If abdominal contents are on view
this is known as evisceration.
If you suspect evisceration:
•d
o not attempt to place
abdominal contents back
into abdominal cavity
•a
pply a non-stick dressing
(or, if unavailable, a moist
pad or plastic wrap) over the
casualty’s organs
• t he non-stick dressing may
then be covered by a loose
bandage.
67
Crush Injuries
A crush injury is caused by
a substantial weight on top
of a casualty. This may lead
to a life-threatening situation.
Signs and Symptoms
A casualty suffering a crush
injury may display the following
range of signs and symptoms:
• large area of the casualty’s
body is involved
•n
o detectable pulse in limb
below crush injury
•p
ale, cool, clammy skin
• r apid, weak pulse.
68
Treatment
For the treatment of a crush
injury do the following:
• DRSABCD
•c
all an ambulance 000
• r eassure the casualty
•a
ll crushing forces should be
removed as soon as possible
• t reat any other injuries
•k
eep the casualty warm.
A fracture is any break in the
continuity of a bone. Fractures
can cause total disability or in
some cases death due to the
severing of vital organs and/
or arteries. First Aid includes
immobilising the fractured
part in addition to applying
lifesaving measures when
necessary. The basic splinting
principle is to immobilise the
joints above and below the
fracture.
Fracture Classification:
Signs and Symptoms
• deformity
Trauma
Fractures
• tenderness
• swelling
• pain
• inability to move the injured
part
• haemorrhage
•b
ruising of skin at the injury
site
• crepitus (a grating noise made
when the ends of fractured
bones rub together).
•A
closed fracture is a broken
bone that does not break the
overlying skin. The tissue
beneath the skin may be
damaged.
•A
n open fracture is a broken
bone that breaks (pierces)
the overlying skin. The
broken bone may come
through the skin.
•A
complicated fracture
involves damage to internal
organs or blood vessels that
are located in the vicinity of
the fracture.
©4-Life
Treatment
Fractures often occur along with
other injuries. Assess which
injury takes priority. For example,
heavy bleeding is more urgent
– and requires higher priority
care – than a fracture.
69
Purposes of Immobilising
Fractures
Immobilise the fracture area on
both sides of the fracture site
(above and below) by using splints
wherever available. A fracture
is immobilised to prevent the
sharp edges of the bone from
moving and cutting tissue,
muscle, blood vessels, and
nerves. This reduces pain and
helps prevent or control shock.
In a closed fracture,
immobilisation keeps bone
fragments from causing an
open wound, which can
become contaminated and lead
to a risk of infection.
Fracture Management
(forearm, upper arm, leg)
• DRSABCD
•c
all an ambulance 000
• r eassure the casualty
•c
heck for a pulse at the base
of limb
• if pulse not present, you may
need to apply gentle traction to
assist with return of circulation
• t reat any wounds
•a
pply an appropriate splint.
Fractured Pelvis
• DRSABCD
•c
all an ambulance 000
• r eassure the casualty
•b
end casualty’s legs at knees,
gently bring them together
and support with bandages
•p
lace folded blanket either
side of the casualty’s hips
for support.
Fractured Jaw
• DRSABCD
•c
all an ambulance 000
• r eassure the casualty
• s upport jaw with pad
• lean the casualty forward to help
with drainage of fluid from mouth
• if the casualty is unconscious,
place in the recovery position.
Splints
Splints may be improvised from
such items as boards, poles,
sticks, newspaper, or cardboard.
70
A sling is a bandage suspended
from the neck to support an
upper extremity. The triangular
bandage is ideal for this purpose.
The casualty’s hand should be
higher than his/her elbow, and
the fingers should be showing
at all times. The sling should
be applied so that the sling is
tied on the unaffected side.
Triangular Bandage Sling
To apply this type of sling:
• insert the triangular bandage
under the injured arm so the
arm is in the centre, the apex
of the sling is beyond the
elbow, and the top corner
of the material is over the
shoulder of the injured side
•p
osition the forearm with the
hand slightly raised
Trauma
Slings
• bring the lower portion of the
triangular bandage over the
injured arm and over the
shoulder of the uninjured side
• t ie the two corners in a nonslip knot on the side of the
neck on the uninjured side
• t wist the apex of the sling
and tuck it in at the elbow.
Collar and Cuff
This sling can be used for
a fractured upper arm:
• t he elbow on the injured side
must hang naturally at the
side of the casualty
• t he hand on the injured side
must be extended towards
the shoulder on the noninjured side
• t he triangular bandage is
used as a clove hitch: form
two loops, one towards you,
one away from you
•p
lace the loops together
by folding both towards
each other
71
•g
ently place the clove hitch
over the hand and pull firmly
to secure on the casualty’s
wrist
•p
lace ends of bandage on
either side of neck
• t ie off on the unaffected side
• t he casualty’s arm should
hang comfortably
• if further support is required,
place another triangular
bandage around the upper
arm and body to maintain
support of arm against body
of casualty
• t his will help restrict
movement.
72
Muscles, tendons and ligaments
all surround bones and joints
and are known as soft tissues.
Tendons attach muscle to the
bone and cross over at the joint.
Ligaments join bone to bone at
the joint. Dislocation can also be
included in soft tissue injuries.
Causes
Many soft tissue injuries are
related to sporting accidents
and may be caused by the
following:
•o
verstretching of a ligament
at the joint, causing a sprain
•p
artial tearing of a muscle
or tendon, causing a strain
•c
omplete tearing of a muscle
or tendon, causing a rupture
•d
eep bruising, causing a
large amount of bleeding
into the muscle.
Signs and Symptoms
•b
ruising and swelling at or
near the injury
•d
ifficulty or reluctance in
moving the affected part
Treatment
The treatment for soft tissue
injury is R.I.C.E:
Trauma
Soft Tissue Injuries
REST to reduce the pain
r cold compress to
ICE o
affected area
COMPRESSION compression
bandage for support
ELEVATE the injury to reduce
swelling.
Rest: ensure that the casualty
is in a comfortable position.
This will also include resting
and carefully steadying and
supporting the injured body
part.
Ice: cool the area with a cold
compress (e.g. an ice pack
wrapped in a cloth). Cool for
10 minutes every 2 hours.
This treatment should be
continued for up to 24 hours
after the injury.
Compression: apply a
compression bandage to the
affected area. This will provide
gentle and even support to
the injury.
•p
ain and tenderness at or
near the injury.
73
Elevation: gently raise and
support the injury in order to
reduce bleeding and therefore
reduce swelling and pain.
74
If pain is severe or the casualty
cannot use the injured part,
further medical assessment
can determine if a fracture
is present.
Medical
MEDICAL
75
Syncope (Fainting)
Syncope (fainting) is defined as
sudden loss of consciousness
due to a decline in blood flow
to the brain. Syncope usually
lasts for less than one minute
and the person makes a full
recovery.
• s udden stress
• s evere pain
•p
rolonged standing
•q
uickly standing upright,
especially after bed rest.
Treatment
Signs and Symptoms
Signs of syncope can include
the following:
• t he person may complain of
feeling light-headed and/or
nausea
• t he person’s heart rate slows
• t he person’s skin is clammy
and pale in colour.
Causes
Syncope may be caused by
lack of blood supply to the
brain due to the following:
76
•a
ssist the person to lie
down flat
•e
levate the person’s legs by
placing on a chair
•e
ncourage the person to take
deep breaths.
If the person remains
unconscious:
• DRSABCD
•c
all an ambulance 000.
If a person complains of feeling
faint, then assist him/her to
sit or lie down immediately to
prevent syncope.
Anaphylaxis is an immediate
and rapid response following
exposure to an irritant that
a casualty is sensitive to.
It is the most severe form
of allergic reaction. If not
treated immediately, it has the
potential to be life-threatening.
Signs and Symptoms
A casualty suffering from
anaphylaxis may demonstrate
signs and symptoms within
minutes of exposure to the
allergen. Such signs and
symptoms could include:
• t he casualty may complain
of a lump in the throat
• wheezing
• t ightness of the chest
Causes
Common causes of
anaphylaxis may include
everyday stimuli such as:
•d
rug reactions
• f ood reactions
• insect stings.
Treatment
If the casualty is conscious
and able to respond to verbal
commands, the following
treatment should be instigated:
• r eassure the casualty and
remain calm
•h
elp the casualty to sit
upright to help casualty’s
breathing
• t he forming of a rash over
most of the casualty’s body
• if the casualty cannot sit
upright then assist him/her
to lie down
•g
eneralised swelling
•c
all an ambulance 000
• hives
• if the casualty is prescribed
medication (EpiPen®)
assist with administration.
Administration technique is
described on the EpiPen®.
• increased heart rate
• t he casualty could collapse
and/or become unconscious.
Medical
Anaphylaxis
Death may occur within minutes
due to respiratory failure.
77
If the casualty is
unconscious:
• DRSABCD
•c
all an ambulance 000
• if the casualty is not
breathing normally,
start CPR.
The casualty who is known to
have a severe allergy may have
an EpiPen® prescribed by his
or her doctor. An EpiPen® is a
pre-loaded dose of adrenaline
that can be injected into the
casualty. Adrenaline can help
reverse the effects of anaphylaxis.
78
EpiPen® use
People with Asthma have extra
sensitive airways. The airways
react by narrowing when they
become irritated. This makes
it difficult for air to move in
and out. The narrowing or
obstruction is caused by:
Causes
•a
irway inflammation, meaning
that the airways in the lungs
become swollen and narrow
• strong fumes
• bronchoconstriction, meaning
that the muscles that encircle
the airways tighten or go
into spasm.
• inhaled irritants
Signs and Symptoms
Asthma attacks can range from
mild to very severe and how a
person’s symptoms appear will
depend on how severe the attack
is. An attack can be recognised
by some or all of the following:
• wheezing
• coughing
• distress
• difficulty with speaking
• s hortness of breath or
difficulty breathing
Common causes of broncho­
constriction can include
everyday stimuli such as:
Medical
Asthma
• cold air
• dust
• exercise
• smoke
• pollen
• animals
• house dust mite.
Treatment
If the casualty has an
Asthma Action Plan, this
plan should be followed.
If the person is conscious
and able to respond to verbal
commands the following
treatment should be initiated:
• r eassure the person and
remain calm
• help the person to sit upright
• skin
is pale/blue in colour.
79
•g
ive 4 separate puffs of a
blue/grey reliever, one puff
at a time
•e
ncourage the person to
breathe in 4 times after
each puff
• if there is no improvement
after 4 minutes, call an
ambulance 000
•c
ontinue to give 4 separate
puffs with 4 breaths in
between
•w
ait 4 minutes between
each set of 4
If the person is unconscious:
• DRSABCD
•c
all an ambulance 000
• if the person is in cardiac
arrest, start CPR.
A person with severe Asthma is
exhausted through the fight to
breathe and can appear quite
calm. This is often a dangerous
stage. Even if medication appears
to be effective, medical advice
should be sought. Call an
ambulance 000.
•c
ontinue until ambulance
arrives
• if available, use a spacer.
Asthmatic using inhaler
with spacer device
80
Hyperventilation means
breathing faster than normal.
Both adults and children can
find hyperventilation very
frightening. Always remember
there are many people who
hyperventilate – this may be due
to a serious illness and must be
treated as such.
Anxiety Related
Hyperventilation
Medical
Hyperventilation
Causes
Hyperventilation is likely to
occur due to the following:
• anxiety
• fear
• emotional stress.
Signs and Symptoms
A person suffering from
hyperventilation may display
signs and symptoms as
follows:
• r apid breathing/shortness
of breath
• rapid heart rate
• anxiety
• visual disturbance
Treatment
The best way to prevent
Hyperventilation is to avoid
situations and activities that
may cause anxiety but if an
attack occurs the following
treatment should be initiated:
• r eassure the person and
remain calm
• tingling in fingers
• r emove the person from
the cause if possible
• s ometimes loss of
consciousness.
•e
ncourage the person to
slow their breathing
The symptoms usually last
20-30 minutes but it may
seem like hours to the
person. Although frightening,
hyperventilation is not usually
dangerous.
•d
o not use a bag for the
person to breathe into
• if the person shows no
improvement call an
ambulance 000.
81
Stroke
Stroke occurs when the arteries
that lead to the brain become
either blocked or ruptured. When
this happens the brain does
not receive the oxygen that is
required and so brain cell death
occurs.
THINK FAST!
Facial weakness
Arm weakness
Speech difficulty
Time to act fast
Causes
Signs and Symptoms
A person suffering from a
stroke may show signs and
symptoms as follows:
• t otal or partial weakness on
one side of the body
• inability to talk
• inability to understand or
remember certain things
• t rouble swallowing
• pain
• numbness
•p
roblems with sight.
The two most common causes
of stroke are as follows:
• a blood clot forms and blocks
blood flow in an artery leading
to the brain
• a cerebral haemorrhage occurs
when a defective artery in the
brain bursts.
Treatment
If the person is conscious
and able to respond to verbal
commands, the following
treatment should be initiated:
• r eassure the person and
remain calm
• loosen tight clothing
•p
rotect the person’s airway
and place the person on his/
her non-paralysed side
•k
eep the person warm
©4-Life
82
•c
all an ambulance 000.
• DRSABCD
•c
all an ambulance 000
• if the person is non-breathing,
start CPR
• if the person is in cardiac
arrest, start CPR.
While a person suffering from
a Stroke may not be able to
communicate he/she may be
able to understand what is
going on about them. Therefore,
it is important to explain all
procedures and to offer constant
reassurance to the casualty.
Medical
If the person is unconscious:
Choking
Choking in a conscious casualty
may occur when the upper
airway, usually the throat or
trachea, is blocked by an
object. The blockage may be
partial or complete. When the
airway is blocked the casualty is
deprived of oxygen. Rapid First
Aid for choking can save a life.
Signs and Symptoms
The casualty suffering from
partial obstruction may display
signs and symptoms as follows:
• s hortness of breath
•b
lue/pale/cold skin
The casualty suffering from
Complete Obstruction may
display signs and symptoms
as follows:
•u
nable to breathe, cough
and/or speak
•c
lutching the throat or chest
• f ace and extremities turning
blue.
Causes
Choking is more likely to
occur due to the following:
• s wallowing large, poorlychewed food
• wheezing
•c
onsumption of large
amounts of alcohol
• coughing
•w
earing poor-fitting dentures
•n
oisy breathing.
• t alking or laughing while
eating.
83
Treatment (Adult, Child)
Ineffective Cough
If the casualty is conscious
and able to respond to verbal
commands and can also
cough effectively, the following
treatment should be initiated:
•g
ive up to 5 back blows
between the shoulder blades
using the heel of your hand.
Effective Cough
• r eassure the casualty and
remain calm
•c
all an ambulance 000
•h
elp the casualty to sit upright
and encourage coughing
•m
aintain continuous checking
of casualty until recovery or
deterioration (deterioration
is recognised if the casualty
turns blue or becomes limp).
If the casualty is conscious but
has an ineffective cough, the
following treatment should be
instigated:
If back blows unsuccessful:
•g
ive up to 5 chest thrusts.
Chest Thrusts
Chest thrusts are similar to
chest compressions in CPR
but sharper and delivered at
a slower rate:
•p
lace dominant hand in centre
of the chest, place other hand
on top and interlock fingers of
both hands
•p
ush down approximately
1/3 depth of the chest, up
to 5 times.
Unconscious casualty
•c
all an ambulance 000
•c
ommence CPR
•C
PR refer page 36.
84
Ineffective Cough
Effective Cough
•p
lace infant in downward
position across your knees
with head lower
• r eassure the casualty and
remain calm
•c
all an ambulance 000
•h
elp the casualty to sit upright
and encourage coughing
•m
aintain continuous checking
of casualty until recovery or
deterioration (deterioration
is recognised if the casualty
turns blue or becomes limp).
Medical
Treatment (Infant)
•g
ive up to 5 back blows
between the shoulder blades
using the heel of your hand.
If back blows unsuccessful:
•g
ive up to 5 chest thrusts.
Chest Thrusts
•p
lace 2 fingers in centre of the
chest
•p
ush down approximately
1/3 depth of the chest, up
to 5 times
(Chest thrust similar to chest
compressions in CPR but
sharper and delivered at a
slower rate)
Unconscious casualty
•c
all an ambulance 000
•c
ommence CPR.
• CPR refer page 36.
85
Febrile Convulsion
Febrile Convulsion can affect
infants and children less than
5 years of age and is caused
by a high temperature (above
38.5 Celsius). The condition is
generally not life-threatening.
Signs and Symptoms
A child suffering from febrile
convulsion may display the
following signs and symptoms:
•p
ossible high temperature
•c
old-like symptoms
•e
yes roll back
• t he child may first become
unconscious, followed by a
stiffening of the legs, arms
and body
• t he head is flung backwards
and the arms and legs
commence jerking
• t he child’s skin colour may
become pale or even turn
blue
• t he convulsion ends after
a few minutes and normal
colour and conscious state
returns.
86
Causes
Common causes of febrile
convulsion include the
following:
• t he child is genetically
predisposed to the condition
• t he child suffers frequent
illness, which includes high
temperature.
Treatment
The following treatment should
be initiated:
•p
osition the child on his/her
side
• r emove the child’s clothing
•d
o not place the child in
cold water
•d
o not over-cool the child
•c
all an ambulance 000.
A child who has suffered a
febrile convulsion must be
transported by ambulance
to hospital to determine the
cause of the convulsion.
Diabetes is a disorder of the
body’s ability to use glucose
(sugar), the body’s main source
of energy.
Two conditions suffered by
a diabetic which may be
encountered by a First Aider
are hypoglycaemia (low blood
sugar) and hyperglycaemia
(High blood sugar)
Treatment
The following treatment should
be initiated:
•c
all an ambulance 000
• if the person remains
conscious and able to
swallow give a sweet drink
(remember not diet drink).
Alternatively, administer 8-10
jelly beans to the casualty
Hypoglycaemia
• r epeat the treatment if the
person responds
Hypoglycaemia is also called
low blood sugar. This condition
occurs when a person’s blood
sugar level drops too low to
provide enough energy for the
body’s activities.
•w
hen the person recovers
and is able to swallow, help
with the administration of
food such as a biscuit, piece
of fruit or sandwich.
Signs and Symptoms
A person suffering from
hypoglycaemia may display
signs and symptoms as
follows:
• hunger
• sweating
• dizziness
• drowsiness
• confusion
• difficulty speaking.
Medical
Diabetes
If the person is unconscious,
place them into the
recovery position
and call an
ambulance
to provide
additional
treatment.
Do not
administer
insulin to a
person suffering
from a
hypoglycaemic
attack.
©4-Life
87
Hyperglycaemia
Treatment
Hyperglycaemia is an increase
in glucose (sugar) circulating in
the blood.
The following treatment should
be initiated:
Signs and Symptoms
Hyperglycaemia has a
slower onset compared to
hypoglycaemia and is also less
common. Signs and symptoms
include:
• excess urine production
• increased thirst
• increase in hunger
• hot dry skin
• t he person may experience
visual disturbance
• tiredness
• t he person may become
unconscious.
•h
igh blood sugar reading
on glucometer.
88
• call an ambulance 000
• if the person is unconscious,
place him/her into the recovery
position. Never place anything
in an unconscious person’s
mouth
•o
ffer reassurance, even to
an unconscious casualty.
A seizure is a sudden change
or disturbance in the way the
cells of the brain function
caused by chaotic electrical
signals.
Signs and Symptoms
The signs and symptoms
may present in different ways
depending on the severity.
• blank staring
• chewing
• wandering
• confused speech.
If the seizure is severe, signs
and symptoms may include:
• collapse
Treatment
The following treatment should
be initiated:
Medical
Seizure (Fitting)
•c
ushion the person’s head
and remove eye glasses
•c
all an ambulance 000
• loosen tight clothing
•p
rotect person from harm
• do not restrain
•d
o not place anything in the
person’s mouth
•o
nce the seizure activity has
finished, place the person
on his/her side
•w
hen the person gains
consciousness, reassure
him/her.
• loss of consciousness
•u
ncontrolled jerky
movements of the person’s
arms/legs/body.
89
Heart Conditions
The heart is a muscle that is
located a little to the left of
the middle of the chest, and
generally it is about the size
of your fist. The heart is like
a pump and it sends blood
around the body. The blood
Chest Pain
Chest pain is usually a sign
of lack of oxygen to the heart
muscle.
•c
all an ambulance 000 to
provide emergency care.
90
provides the body with the
oxygen and nutrients it needs.
The heart is a pump that
should beat regularly. Certain
heart conditions can create an
irregular pulse.
Heart Attack and angina
can present in a very similar
way and it can be difficult to
determine between the two.
Signs and Symptoms
•c
hest pain or discomfort
•p
ain or heaviness in the
arms, shoulders, throat
and/or jaw
• sweating
• breathlessness
• collapse.
If the person is unconscious:
• DRSABCD
Medical
Angina and Heart Attack
•c
all an ambulance 000
• if the person is in cardiac
arrest, start CPR.
A person who has been
diagnosed with angina
may also be prescribed a
medication by their doctor.
This medication is taken as
a spray or tablet beneath
the tongue. If the person has
this medication it must be
administered by the person
not by the First Aider.
Treatment
If the person is conscious
and able to respond to verbal
commands the following
treatment should be initiated:
• DRSABCD
•c
all an ambulance 000
• r eassure the person and
remain calm
• loosen tight clothing
• r estrict activity and ensure
that the person rests.
91
Poisoning
Poisoning can be defined as
substances entering the body
either through inhalation,
absorption, injection, or skin
contact which cause injury,
illness or death.
Causes
Causes of poisoning can
include the following:
• inhalation of substance
• absorption
• injection of substance
Signs and Symptoms
• s kin contact.
Look for these signs and
symptoms if you suspect
poisoning:
Treatment
•b
urns or redness around the
mouth and lips, which can
result from drinking certain
poisons
• breath that smells like
chemicals, such as petrol,
insecticide or other
chemicals
• burns, stains and odours
on the casualty or his/her
surrounds
• vomiting
Swallowed Poisons
Note that some poisons
may not cause immediate
symptoms in a casualty.
In some instances, it may
be several hours before
symptoms show. However,
damage may still be occurring
during this time. If you suspect
a casualty has swallowed
poison you should do the
following:
•d
ifficulty breathing
• t ake the container with you
to the telephone
•a
ltered conscious state/
confusion.
•C
ALL POISON INFORMATION
CENTRE 13 11 26
•c
all an ambulance 000
•D
O NOT make the patient
vomit.
92
Poison Safety
If a casualty has absorbed
poison through the skin:
Remember the following key
points relating to poison safety
in the home and workplace:
• t horoughly flush the area
immediately with copious
amounts of water
•C
ALL POISON INFORMATION
CENTRE 13 11 26
•c
all an ambulance 000
•c
ontinue to flush with running
water until ambulance
personnel arrive
•e
nsure no-one else on scene
is affected.
Inhaled Poisons
If inhalation of poison is a
possibility, the First Aider
should suspect an inhalation
injury even if there are no
apparent signs and symptoms.
In such an instance:
•m
ove the casualty to fresh
air quickly without putting
yourself in danger
• if safe to do so, open
windows and doors wide
•C
ALL POISON INFORMATION
CENTRE 13 11 26
•c
all an ambulance 000.
Medical
Absorbed Poisons
•k
eep medicines and
chemicals out of sight and
out of reach in a locked or
child-resistant cupboard
•d
o not leave chemicals
unattended whilst in use
• r ead directions for use
carefully
•d
o not decant chemicals
•a
lways purchase household
products with child-resistant
packaging
•a
void taking medication in
front of small children.
POISON
INFORMATION
CENTRE
13 11 26
24 HOURS A DAY
ANYWHERE
IN AUSTRALIA
93
Drug Overdose
A drug is usually a substance
used to treat an illness, relieve
a symptom or prevent disease
in the body. It comes in many
forms such as capsules, tablets,
powders, liquids, aerosols and
pastes. A doctor’s prescription
is generally required for the
purchase of most drugs.
However, the use of illegal drugs
in our communities is very
common and can lead to major
health problems or even death.
Prescription and
Non-Prescription Drugs
Prescription drugs require a
doctor’s prescription to be
written prior to purchase. Less
dangerous non-prescription
drugs can be purchased over
the counter from pharmacists
or supermarkets.
Natural and Synthetic
Drugs
A natural drug is made from
a plant or animal. Most
medicines prescribed by a
doctor are synthetic as they
are made from chemicals.
94
Legal and Illegal Drugs
Legal drugs, whether
prescription or nonprescription, can be bought
in pharmacies and shops.
Illegal drugs are those that
are imported, grown or
manufactured illegally. Often,
illegal drugs are dangerous
and cause the user to become
addicted. Some examples of
illegal drugs include cocaine,
heroin, ecstasy and marijuana.
Overdose
A drug overdose occurs when
you consume more drugs than
your body can tolerate. Drugs
affect how the body works.
When taken incorrectly or as
an overdose they may be very
toxic to the body and cause
serious injury or death.
Care and Treatment
A drug overdose may be
a life-threatening situation
depending on the type of drug
and the amount taken.
If a person is suffering from a
drug overdose you should do
the following:
A person suffering from a drug
overdose may display the
following signs and symptoms:
•a
ltered level of conscious
state
• unconsciousness
Medical
Signs and Symptoms
• DRSABCD
• call an ambulance 000
• if unconscious place in
recovery position
• if the casualty is in cardiac
arrest, start CPR.
• blurred vision
• slurring of speech
• pinpoint pupils
• slow shallow respiration
POISON
INFORMATION
CENTRE
• s low pulse or, alternatively,
rapid weak pulse
13 11 26
•e
vidence of needle injection
marks
24 HOURS A DAY
• respiratory arrest
• cardiac arrest
•e
mpty medication
containers/packets.
ANYWHERE
IN AUSTRALIA
95
Heat Exhaustion
Heat Exhaustion is a common
condition seen by First Aiders
and occurs when people
exercise (work or play) in a
hot, humid place and their
body fluids are lost through
sweating, causing the body
to overheat.
Signs and Symptoms
The following are the most
common symptoms of heat
exhaustion although each
individual may experience
symptoms differently:
• profuse sweating
• pale skin
• t he person may feel faint
or may collapse
• nausea
• t he person complains
of a headache.
96
Treatment
For the treatment of heat
exhaustion, initiate the
following care:
•c
all an ambulance 000
• r eassure the casualty and
remain calm
• r elocate the casualty to
a cool place
• r emove enough clothing to
cool the casualty without
chilling him/her
• lightly fan the casualty’s skin
•a
pply/wrap ice packs to
casualty’s groin and armpits
•a
dminister oral fluids (water),
small frequent amounts.
Heatstroke is a life-threatening
condition. It is due to the body’s
elevated temperature. Heatstroke can be caused by many
different situations such as:
Treatment
•e
xcessive exercise and
excessive heat.
•c
all an ambulance 000
Signs and Symptoms
• r elocate the casualty to a
cool place
The following are the most
common symptoms of heatstroke although each individual
may experience symptoms
differently:
• headache
• dizziness
•d
isorientation, agitation or
confusion
•h
ot dry skin that is flushed
but not sweaty
• high body temperature
• altered conscious state
• rapid shallow breathing
• increased pulse rate and
breathing.
For the treatment of heatstroke
implement the following care:
Medical
Heatstroke
• DRSABCD
• r eassure the casualty and
remain calm
• r emove enough clothing to
cool the casualty
• lightly fan the casualty’s skin
•a
pply/wrap ice packs to
casualty’s groin and armpits
•g
radually cool the body with
tepid sponging or wet cloths.
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
•p
lace the casualty on
his/her side
• if the casualty is in cardiac
arrest, start CPR.
97
Hypothermia
Hypothermia is a condition in
which the person’s core body
temperature has dropped to
significantly below normal
(35 degrees Celsius).
Causes
The main causes of hypo­
thermia are:
• immersion in cold water
•e
xposure to a cold
environment.
Signs and Symptoms
The following are the most
common symptoms of
hypothermia although each
individual may experience
symptoms differently:
• shivering
• confusion
•c
hange in conscious state/
unconsciousness
•d
ry cold skin.
98
Treatment
For the treatment of
Hypothermia initiate the
following care:
• DRSABCD
•c
all an ambulance 000
•h
andle the casualty gently
and remove him/her from
cold environment
• if clothing is wet, carefully
remove.
If casualty is conscious and
shivering:
• r e-warm the casualty slowly
(e.g., wrap in warm blankets
or clothing)
• t reat for shock.
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
•p
lace the casualty on his/her
side
• if the casualty is in cardiac
arrest, start CPR.
Medical
CAUTION
•d
o not rub or massage
the casualty
•d
o not give alcohol
•d
o not use hot water bottles
or place the casualty in hot
water.
Mild hypothermia casualty
conscious and shivering
99
Drowning
Drowning is second only to
motor vehicle accidents as a
cause of accidental death in
Australia.
Signs and Symptoms
The casualty who has been
rescued may display:
• s hortness of breath
• DRSABCD
•c
all an ambulance 000
•d
ue to drowning, a large
amount of water may be
in the mouth. This can
be drained by turning the
casualty on to their side
•b
lue/pale/cold skin
• if the casualty shows no
signs of life, start CPR
• unconsciousness
•C
PR refer to page 36.
• non-breathing.
Treatment
If the casualty is conscious
and able to respond to verbal
commands the following
treatment should be initiated:
• r eassure the casualty and
remain calm
• help the casualty to sit upright
and take regular deep breaths
•c
all an ambulance 000
• if the casualty is cold,
warm with blanket.
100
If the casualty is unconscious:
Never cancel an ambulance
even if the casualty appears to
have made a full recovery. It is
imperative that the casualty is
seen at a hospital as his/her
condition may deteriorate.
Bites and Stings
BITES AND STINGS
– ENVENOMATION
101
Snakes
Approximately 70% of Australian
snakes are venomous. Venom
can be a lethal substance and
may cause a diverse array of
reactions in a casualty.
Not everyone that is bitten
by a snake is poisoned.
Treatment
•w
here possible, apply an
immobilisation splint. (Do
not remove once in place)
•d
o not wash the bite site as
this may be used for venom
detection
The main goal of treatment
is to restrict the transport of
venom through the body:
•d
o not apply a tourniquet
or constrictive bandage.
•c
all an ambulance 000
Pressure Immobilisation
Bandage Technique
•m
ake a thorough physical
assessment and, where
possible, identify the snake
•o
ffer the casualty reassurance
and try to relax him/her both
physically and psychologically
•a
pply a firm pressure
immobilisation bandage
technique (see below) to
the affected area/limb
Anyone suspected
of being bitten
should be treated.
102
• apply a second roller bandage,
starting at the toes or fingers
and continuing up the limb
Apply a wide bandage over the
bite site. This bandage should
be firm but still allow blood
flow to the limb.
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
• if the casualty is in cardiac
arrest, start CPR.
Red-Back
The venom takes a long
period of time to act, causing
complications up to three
hours later. The venom is rarely
life-threatening in adults.
©4-Life
Bites and Stings
Spiders
Signs and Symptoms
A casualty suffering from
a red-back spider bite may
display the following signs
and symptoms:
• immediate pain at the bite
site, and pain to increase
with time
• s kin may appear red
•p
rofuse sweating at the
bite site
• s kin may be hot to touch
at the bite site
• local swelling at bite site
• nausea/vomiting
•a
bdominal pain
Treatment
Treatment should proceed
as follows:
•o
ffer the casualty reassurance
and try to relax him/her both
physically and psychologically
•m
ake a thorough physical
assessment
•a
pply ice to the bite site
and elevate. (Do not apply a
pressure bandage as this will
increase the pain)
•u
ndertake constant
assessment of the casualty
•c
all an ambulance 000.
•b
lurred vision.
103
Funnel Web
Treatment
The funnel web is more
commonly found in the
eastern states and a person
is more likely to be bitten at
night. Deaths are rare due
to availability of appropriate
treatment.
The main goal of treatment
is to restrict the transport of
venom through the body.
The male is highly aggressive
when disturbed or cornered
and is able to inflict multiple
strikes with its hardened fangs.
Signs and Symptoms
A casualty suffering from a
funnel web spider bite may
display the following signs and
symptoms:
•p
rofuse sweating and
salivation from the mouth
• s kin may be cold and the
casualty may shiver
• local swelling at bite site
• nausea/vomiting
•a
bdominal pain
•b
lurred vision.
• DRSABCD
•c
all an ambulance 000
•m
ake a thorough physical
assessment
• offer the casualty reassurance
and try to relax him/her both
physically and psychologically
•a
pply a firm pressure
immobilisation bandage
technique to the affected
area/limb (Refer to page 102)
• apply a second roller bandage,
starting at the toes or fingers
and continuing up the limb
•w
here possible, apply an
immobilisation splint. (Do
not remove once in place)
•d
o not wash the bite site as
this may be used for venom
identification
•d
o not apply a tourniquet
or constrictive bandage.
Anyone suspected
of being bitten
should be treated.
104
Bee, wasp and ant stings are
painful but are generally not
life threatening unless the
casualty is allergic.
(Refer to anaphylaxis page 77).
Treatment
The main goal of treatment
depends on the presentation
of symptoms:
• DRSABCD
•c
all an ambulance 000
Bites and Stings
Bee, Wasp and Ant Stings
•m
ake a thorough physical
assessment
•o
ffer the casualty
reassurance and try to relax
him/her both physically and
psychologically
©4-Life
Signs and Symptoms
A casualty suffering from
an insect sting or bite may
experience:
• itchy skin
• rash
• swelling of the area
• nausea/vomiting
•a
ltered state of
consciousness/collapse
• s hortness of breath.
• r emove the sting by scraping
but do not squeeze the sting
as this will release more
venom
•a
pply an ice pack or cold
compress to the site for relief
of pain
• if the casualty has an allergic
reaction, call an ambulance
000 and apply pressure
immobilisation bandage
technique (Refer to page 102).
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
• if the casualty is in cardiac
arrest, start CPR.
105
Marine Creatures
Blue-Ringed Octopus
Treatment
The blue-ringed octopus is
a common octopus species
which can be found in
crevices and under rocks at
the seashore. It can be found
in most states of Australia.
The Blue Ringed Octopus is
not normally aggressive and
attacks only if provoked.
It is the most venomous
octopus in the world.
The main goal of treatment
is to restrict the transport of
venom through the body:
Although bites are infrequent
they are known to be harmful
due to the effect on breathing.
Signs and Symptoms
A casualty suffering from a
blue-ringed octopus sting
may present the following
symptoms:
•p
ainless bite site with a
visible spot of blood
•n
umbness in the lips, tongue,
face and neck within minutes
•c
all an ambulance 000
•m
ake a thorough physical
assessment
•o
ffer the casualty reassurance
and try to relax him/her both
physically and psychologically
•a
pply a firm pressure
immobilisation bandage
technique to the affected
area/limb (Refer to page 102)
•w
here possible, apply an
immobilisation splint. (Do
not remove once in place)
•d
o not wash the site as this
may be used for venom
identification
•d
o not apply a tourniquet or
constrictive bandage
If the casualty is unconscious:
• v isual disturbances
• DRSABCD
•d
ifficulty speaking
•c
all an ambulance 000
•g
eneralised weakness
• if the casualty is in cardiac
arrest, start CPR.
• t he casualty may collapse
requiring resuscitation.
106
• DRSABCD
Treatment
The cone-shell has venom
glands and can inject venom
when handled or stepped
on. The venom can cause
progressive muscle weakness
that can lead to sudden death.
The main goal of treatment
is to restrict the transport of
venom through the body:
Although bites are infrequent
they are known to be harmful
due to the effects on breathing.
•m
ake a thorough physical
assessment
Signs and Symptoms
•p
ainless bite site with a
visible spot of blood
•n
umbness in the lips,
tongue, face and neck within
minutes.
• v isual disturbances
•d
ifficulty speaking
•g
eneralised weakness
•p
aralysis of respiratory
muscles leading to difficult
breathing
• r espiratory arrest
• t he casualty may collapse
requiring resuscitation.
• DRSABCD
•c
all an ambulance 000
Bites and Stings
Cone-Shell
• offer the casualty reassurance
and try to relax him/her both
physically and psychologically
•a
pply a firm pressure
immobilisation bandage
technique to the affected
area/limb (Refer to page 102)
•w
here possible, apply an
immobilisation splint. (Do
not remove once in place)
•d
o not wash the site as this
may be used for venom
identification
•d
o not apply a tourniquet
or constrictive bandage.
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
• if the casualty is in cardiac
arrest, start CPR.
107
Box Jellyfish
Treatment
Box jellyfish are pale blue and
transparent. They are cubeshaped with four distinct sides,
hence their name.
The main goal of treatment
is to restrict the transport of
venom through the body:
They are usually found in
tropical regions.
Signs and Symptoms
A casualty suffering a sting from
a box jellyfish may display the
following symptoms:
• s evere pain of the affected
area
•b
listering and red marking
on skin
• altered state of consciousness
• DRSABCD
•c
all an ambulance 000
•m
ake a thorough physical
assessment
•o
ffer the casualty
reassurance and try to relax
him/her both physically and
psychologically
• r emove any tentacles from
the patient. This can be done
by washing the area with
large amounts of vinegar
(first wash then try to remove)
• s hortness of breath
•a
pply cold packs or wrapped
ice to relieve pain.
• r espiratory arrest
If the casualty is unconscious:
•h
eart irregularities.
• DRSABCD
•c
all an ambulance 000
• If the casualty is in cardiac
arrest, start CPR.
108
Treatment
Stonefish and Bullrouts have
many spines that inject venom
deeply under the casualty’s
skin. This causes severe pain.
The main goal of treatment
is to restrict the transport of
venom through the body:
Signs and Symptoms
•o
ffer the casualty
reassurance and try to relax
him/her both physically and
psychologically
A casualty suffering from
stone fish or bullrout venom
may display the following
signs and symptoms:
• intense pain at the site of
injury
• s welling at the site
•a
n open wound may be
present at the site
•b
arbs may still be visible
• t he casualty may be very
anxious
•a
local grey/blue
discolouration and/or
bleeding.
•m
ake a thorough physical
assessment
Bites and Stings
Fish Stings
• s ubmerge the affected area
in hot water (as hot as can
be tolerated by the casualty)
•d
o not restrict movement of
the limb
•c
all an ambulance 000.
If the casualty is unconscious:
• DRSABCD
•c
all an ambulance 000
• if the casualty is in cardiac
arrest, start CPR.
109
Tick Bite
Treatment
The tick is very small and may
attach anywhere to the body
such as hairy areas and in
body crevices. It can cause
paralysis and allergic reactions.
Prompt removal of the tick
is essential.
Signs and Symptoms
• local skin irritation
• tiredness
• muscle weakness
• double vision
• breathing/difficulty swallowing.
110
• r emove tick with forceps by
pressing down skin around
tick’s mouth part
•w
ith forceps, grip mouth part
firmly but slowly and gently
remove
• avoid squeezing tick
• seek medical help.
Advanced First Aid
ADVANCED FIRST AID
111
Triage – Prioritisation
of Casualty Treatment
The word triage comes from
the French word trier, which
means ‘to sort’. It is a system
of rapidly identifying casualties
who have life threatening
injuries and who have the
best chance of survival. This
system is generally used in a
mass casualty situation. Only
commence a triage system
when there are two or more
injured people. For a single
casualty, always implement
First Aid.
As a First Aider at a mass
casualty scene you may have
to choose patients who require
immediate transport to the
hospital to save their lives as
opposed to patients who can
wait for help later. This can be
a very difficult and traumatic
task.
In most situations you will
be relieved of this task by an
ambulance paramedic.
112
To triage effectively you will
need to be objective and
consider the following:
•d
o not treat the deceased
•g
ive CPR to a casualty in
cardiac arrest ONLY if there
are NO other seriously
injured casualties who
require urgent treatment
• r emove those casualties who
can be helped by immediate
transportation
•d
elay transportation of
casualties whose condition
will not be affected by delay
• t reat casualties with minor
injuries and the walkingwounded who need help
less urgently last
•a
llocate your limited first aid
assistance and resources to
those who are most likely
to survive.
Trauma from road accidents is
one of the leading causes of
accidental death and serious
injury in Australia, despite the
develop­ments in manufacturing
of motor vehicles such as
air bags, crumple zones and
seat belts.
The First Aider is often first at
the scene of an accident and
may dramatically influence the
outcome for the casualties
involved. First Aiders need to
remain calm and provide
systematic assistance.
If you are involved in attending
a road accident, the following
approach should be applied:
• other road traffic
• stability of the vehicle
• sharp objects
• potential for fire.
Remember do not enter the
scene unless everything is
secured and safe.
Advanced First Aid
Road/Machine Accidents
Manage the Scene
A road accident scene may
become chaotic. Remain calm
and give good clear directions
to bystanders so they can help
you manage the situation.
Make sure an ambulance has
been called 000.
Approaching the
Incident – Hazards
Safety is your first priority.
Be aware for hazards to
yourself, bystanders and
the casualty, which
can include:
• power lines
• fuel
©4-Life
113
Assess the Scene
• DANGER
It is important to gather relevant
information about the scene
and what has happened. Relay
this information to Emergency
Services on placing the initial
phone call. Important
information includes:
• RESPONSE
• t he number of casualties
involved
Treat the casualties for shock,
keep them warm and reassure
them about their situation.
• the number of fatalities
• t he number of unconscious
casualties
•w
hether any casualties are
trapped.
Treatment
Approach the management
of the casualties requiring
treat­ment as per the primary
assessment (Refer to page 42).
Remember that the Emergency
Action Plan (DRSABCD) to be
followed during the treatment
and care of a casualty
comprises six steps:
114
• SEND FOR HELP
• AIRWAY
• BREATHING
• COMPRESSIONS
• DEFIBRILLATION
Removal of the casualties from
the vehicle should only be
performed if they cannot be
managed due to the following:
• fire (rare event)
• t he First Aider is unable to
manage the casualty’s airway
• t he First Aider is unable to
manage severe bleeding
• t he First Aider needs to
perform CPR.
When the ambulance crew arrives
give an accurate handover of
what has happened, including
the condition and treatment of
casualties. The details you
provide are very important as it
will assist in the manage­ment of
the casualties by ambulance
personnel and later by medical
staff at the hospital.
A diving emergency could be
any casualty who has suffered
an emergency underwater
regardless of depth which has
affected their state of health.
Scuba divers breathe air from
a tank via a regulator. This
ensures the correct amount
of air is delivered to the diver.
If a diver suffers from an
emergency condition whilst
diving, it is very important that
medical treatment is initiated
as soon as possible.
The rapid ascent causes nitrogen
gas to become trapped in
the tissues of the body. This
trapped gas may find its way
into the diver’s bloodstream.
Signs and Symptoms
Advanced First Aid
Diving Emergencies
A casualty suffering from
DCS may display a range
of symptoms including:
• fatigue
•d
eep pain to muscle
and joints
• itchy skin
DECOMPRESSION
SICKNESS (The Bends)
•p
ins and needles
A serious diving emergency
is decompression sickness
(DCS), otherwise known as
The Bends. This happens when
the diver ascends too quickly
to the water’s surface.
•c
hoking or coughing
• paralysis
• r apid breathing
• unsteadiness/staggering
when walking
•c
hest pain
• unconsciousness.
©4-Life
115
Treatment
Ruptured Lung
For treatment of DCS do the
following:
A diver can suffer a ruptured
lung.
• DRSABCD
•c
all an ambulance 000
Treatment
• call Divers 24-hour Emergency
Service 1800 088 200
To treat a ruptured lung do the
following:
• r eassure and calm the
casualty
• DRSABCD
• lie flat
• if the casualty is in an
altered conscious state or
is unconscious, place in a
recovery position
• if oxygen therapy is available,
administer 100% high flow
oxygen
• if the casualty is experiencing
difficulty with breathing
the First Aider may have
to support into an upright
position
•k
eep the casualty warm.
•c
all an ambulance 000
• call Divers 24-hour Emergency
Service 1800 088 200
• r eassure and calm the
casualty
• if the casualty is in an
altered conscious state or
is unconscious, place in
recovery position
• if oxygen therapy is available,
administer 100% high flow
oxygen
• if the casualty is experiencing
difficulty with breathing the
First Aider may have to
support into an upright
position
•k
eep the casualty warm.
116
Treatment
The eardrum is a thin
membrane that separates the
inner ear from the outer ear.
A Ruptured Eardrum means
that it has a tear or hole in
it. This may be caused by
a change in pressure whilst
diving.
To treat a Ruptured Eardrum
do the following:
•p
lace a clean sterile pad
over the affected ear
• s eek medical advice.
Do not place any fluid or
drops in ear unless prescribed
by a doctor.
Advanced First Aid
Ruptured Eardrum
Signs and Symptoms
A casualty suffering from a
ruptured ear drum may display
the following symptoms:
• s udden, sharp ear pain
•b
leeding or discharge from
the ear
•h
earing loss
• r inging in the ear
• dizziness.
117
Behavioural Emergencies
Abnormal behaviour may be
due to many medical factors.
A casualty suffering from
abnormal behaviour should be
approached with safety as
your main priority.
Treatment and Approach
•c
all an ambulance 000
•a
ssume the same eye
contact level in order to
reduce the feeling of being
stood-over (which may
distress the person)
• s peak in a non-judgmental
manner in order to minimise
any feelings of guilt the
person may be experiencing
•a
llow the person time to
respond to your questions.
If you rush to get answers
to your questions you may
agitate the person and cause
further distress
118
•a
void sudden movements, as
the person may see these as
a threat
•d
o not touch the person
without his/her permission,
as the person may see this
as a threat and believe that
you are going to harm them
•a
pproach the person with
caution: never place yourself
in danger
•n
ever turn your back to the
person
•p
osition yourself so you have
the ability to exit quickly if
necessary.
Assessing the situation is
always the main priority to
ensure your personal safety
and that of others. The First
Aider must take precautions
to avoid confrontation at all
times. Remember that support
and understanding of a person
with an abnormal behaviour is
very important.
Oxygen is a colourless,
odourless gas. The body
requires oxygen for normal cell
function and obtains it through
the respiratory and circulatory
systems. The atmosphere
contains approximately
21% oxygen, of which 4-5% is
used by the body while at rest.
If the body is under stress or
has a disorder of the respiratory
or circulatory system, oxygen
demands are increased. That
demand can exceed the body’s
ability to deliver adequate oxygen
to the tissues. At these times,
providing a supplementary
external source of oxygen can be
of great benefit to the casualty.
Oxygen should be used in the
following situations:
•c
ardiac and respiratory arrest
• altered state of consciousness
• shock
• s hortness of breath,
whatever the cause
•c
hest pain
• s evere injury or trauma
•b
lood loss
Oxygen Therapy Delivery
Systems
Oxygen can be delivered to
a casualty by the following
devices:
•F
ace Mask (Hudson)
•N
ebuliser Mask
Advanced First Aid
Oxygen Administration
•S
oft Bag and Mask Device.
Face Mask (Hudson)
Features of the Hudson Face
Mask are:
• it has a series of holes to
allow air to mix with oxygen
on inspiration; these holes
allow exhaled air to escape
and prevent the build up of
carbon dioxide
• t he percentage of oxygen
inspired depends on flow
rate, and rate and depth of
the person’s respirations
• t hat it is
used at a
flow rate
of at least
8 lpm in an
emergency
setting.
• seizures.
119
Nebuliser Mask
Medical Oxygen
This is the same
as a face mask
except that:
Medical oxygen is supplied in
the following ways:
• it has an
attachment that
enables reliever
medication to
be administered
•a
luminium cylinders
•o
xygen and reliever
medication are administered
at the same time.
Soft Bag and Mask
The primary use of the soft
bag and mask device is
to ventilate non-breathing
patients. This device:
• should be used to deliver high
concentrations of oxygen to
critically ill breathing casualties.
A bag valve mask on a
breathing patient has a nonrebreathing valve to permit
the escape of exhaled air
•m
ust use supplemental
oxygen of at least 8 lpm
• is more effective at flow rate
of 14 lpm
•c
an deliver
80 to 95%
concentration
of oxygen.
120
•m
etal cylinders
•c
arbon fibre/fibre glass wrap
cylinders.
Oxygen is stored at a pressure
of approx 15,000 kPA or 200
PSI. Oxygen is delivered from
the cylinder via a regulator which
reduces the pressure to a safe
working pressure of 414 kPA.
The valve on medical oxygen
cylinders is a yoke type with
holes on the valve stem.
These holes and the pins on
the regulator ensure that only
medical grade oxygen can
be used with medical oxygen
delivery devices. The pin
fittings also prevent the fitting
of an incorrect regulator.
Cylinders are available in the
following sizes
(when full):
•B
– 200 litres
•C
– 400 litres
•D
– 1500 litres
•G
– 7600 litres.
• inlet connections comply
with
national
standards
to prevent
connection
to incorrect gas cylinders
• t he system is protected from
dust and grit by 3 filters
•c
ontents gauge is fitted with a
safety back to relieve pressure
in event of gas leakage
Storage and handling points to
consider:
•c
ylinders should always be
placed on side
•h
andle cylinders with care –
avoid knocking or dropping
• do not lift by valve or regulator
•c
ombustible materials such
as OIL or GREASE must not
come into contact with the
cylinder, regulator, fittings,
valves, or hoses
Flow Meters
•d
o not seal outlets with
adhesive tape, because most
are petroleum-based – static
spark can be generated on
removal use acetate bags
and rubber bands
•F
low meters allow for
variable rates of oxygen to
be delivered depending on
the needs of the casualty.
• s tore below temperature of
50 degrees
• r egulator is also protected
from delivery of excessive
pressure by safety valves.
Storage and Handling
of Cylinders
The storage of oxygen must
meet the requirements of each
State or Territory. Contact
relevant government officials to
determine the correct procedures
relevant to your situation.
Advanced First Aid
Medical Oxygen Regulators
•n
ever smoke in any area where
oxygen is used or stored
•e
nsure the cylinder is within
5 years of last test date
before refilling
•o
xygen cylinders must be
secured during transport
•o
nly use with correct, current
checked regulator (never
modify equipment)
• do not use damaged cylinders
– tag and send for inspection.
121
Daily Checks
Oral Airway Sizing
To maintain good safety
standards with the use of
oxygen it is important to
perform daily checks with
oxygen equipment. Ensure the
following:
To select the correct airway
in an unresponsive casualty:
• t he bottle is medical oxygen
(black and white bottle)
•p
lace the airway against the
side of the casualty’s face
• it should extend from the
corner of the mouth to
the angle of the jaw.
• t he bottle is clean and free
of grease and oil
Oral Airway Insertion
• t here is no damage to
oxygen bottle
To insert the oral airway into
an unresponsive casualty:
• t he bottle is full of oxygen.
•o
pen the casualty’s mouth
Oropharyngeal Airway
• insert the oral airway with tip
pointing up to avoid pushing
the tongue backwards
Oral airways are designed to
keep the tongue from falling
back and blocking the upper
airway. This plastic device has
a rigid flange and a hollow
curved tube.
Oral airways are only used
in unresponsive casualties
who do not have a gag reflex.
The airway must be inspected
prior to inserting an airway
device to remove any potential
obstruction.
• r otate the oral airway
tip slowly 180 degrees
downward until the curve of
the oral airway matches the
curve of the tongue
• t he flange of the oral airway
should rest against the
casualty’s lips.
Oral airway insertion
122
A large percentage of the
population at some point
during their lives will suffer from
a back injury. The spine is a
very complex structure, with a
delicate spinal cord protected
by the vertebrae. Between the
vertebrae are discs, which have
a tough outer casing and a
jelly-like centre.
Many back problems are caused
by the ligaments and muscles
in the lower back becoming
weakened which in turn leads to
the discs becoming weakened.
In certain types of back injury
the outer covering of the disc
can split, allowing the jelly-like
contents to squeeze out. If this
occurs it may lead to severe
pain and a chronic debilitating
injury. Another frequent cause of
back injury is the lifting of heavy
objects whilst not maintaining
correct posture and lifting
techniques.
Being overweight and not
exercising enough can also
increase your risk of a back
injury.
Avoiding Back Injuries
• t ake frequent small breaks
and rest between lifts if
you are lifting a number of
objects
•m
ake sure you do not strain
to lift. If you have to strain to
carry the load, it is too heavy
Advanced First Aid
Back Care (Care of the Spine)
•m
ake sure you have enough
room to lift safely. Clear a
space around the object
before lifting it
• look around before you lift,
and look around whilst you
carry. Make sure you can see
where you are walking. Know
where you are going to put
down the load
•a
void walking on slippery,
uneven surfaces while
carrying a load
•g
et help before you try to
lift a heavy load. Use a
mechanical appliance to
move the load
•m
aintain the normal curves
of the spine when standing,
sitting or lifting a load (See
next section). This will provide
support for ligaments, joints
and discs underneath.
123
Lifting or Moving a Load
•u
se slow and controlled
movements
•h
urried, uncontrolled
movements can strain the
muscles in your back
Remember the management of
your back and the prevention
of injury is in your hands. A
chronic back injury will affect
your quality of life significantly.
•k
eep your body facing the
load whilst lifting. Twisting
while lifting can cause a
serious injury
•k
eep the load close to your
body. Having to reach out
to lift and carry a load may
cause a back injury
• t ry to carry the load in the
space between your shoulder
and your waist. This puts
less strain on your back
muscles
• lift with your legs not your
back; bend your knees and
not your back
• t o pick up the load, keep
your back straight, balance
feet on floor, bend from the
hips and knees and avoid
twisting the body
•w
here possible, slide instead
of carrying.
124
Acute Management
of a Painful Back
• s top the aggravating activity
• r est, preferably in a lying
position on a firm surface
•u
se icepacks to reduce
inflammation and pain
• s eek medical advice for a
thorough assessment even
if pain subsides.
Emergency childbirth may
be due to a woman’s labour
proceeding so fast (especially
if she is having her second or
subsequent baby) that there
is not enough time for medical
help to arrive before the baby
is born.
If you are the only person
present at such a birth,
remember that birth is a natural
process and that you are
there to provide support and
assistance to the mother as
required.
The majority of births are not
life-threatening emergencies.
Preparing for Birth
In you are present during
emergency childbirth:
•c
all for an ambulance 000
•m
ake the room warm and
the mother comfortable
with pillows
•p
lace a clean sheet beneath
the mother and, if possible,
a plastic sheet beneath the
clean sheet
• r eassure the mother and
remain calm
•d
o not be alarmed if there
is a lot of fluid, some of it
bloodstained: this is normal.
The Three Stages of Labour
Stage One
• t he mother experiences
regular contractions. The
strength and frequency of
contractions will increase
over a period of time
Advanced First Aid
Emergency Childbirth
•d
uring pregnancy a mucus
plug has formed a barrier
between the mother’s uterus
and vagina. This will be
expelled as a bloodstained
discharge
• t here may be a slow trickle
or a sudden gush of fluid
from the vagina, which is the
fluid from around the baby
being released from the
membranes. This is known as
the breaking of the waters.
Stage Two
•c
ontractions become much
stronger and are usually
accompanied by an urge
to push
125
• t he baby may place pressure
on the rectum and may cause
the mother to use her bowels
•a
dvise the mother to push
only when she is a having
a contraction, so that the
two forces combine to expel
the baby
• once the cervix is fully dilated,
the baby proceeds down the
birth canal and the head
rotates and appears at the
opening
•a
s the head emerges, it
rotates again to help the
shoulder out. Do not pull
on the baby; it will deliver
naturally without force
After the baby has been born,
the mother’s uterus continues
to contract to expel the
placenta, or afterbirth. The
contraction also prevents
excess bleeding from the wall
of the uterus as the placenta is
pulled away. This completes
the third and final stage of
labour. At this time:
•d
o not place pressure or
pull on cord
• r etain placenta for
examination at hospital
•b
reast feeding a baby
directly after birth will help
with uterine contraction
• if the umbilical cord is around
the baby’s neck, place two
fingers beneath the cord and
slide it over the baby’s head.
The second stage of labour
ends when the baby emerges
completely from the mother’s
birth canal.
Stage Three
• t he umbilical cord can be left
uncut until help arrives or
until mother and baby reach
hospital. It may appear to
pulsate for a few minutes
• if the umbilical cord has to
be cut, tie in two places
25cm and 30cm from the
baby. Cut between these ties
©4-Life
126
• t he placenta (afterbirth)
will come out of the vagina
between 10 to 40 minutes
following birth.
Care of Newborn Infant
Once the baby is born the First
Aider should:
•w
ipe mucus from both nose
and mouth while holding the
baby
Care of Mother
Following the birth the
First Aider should:
•o
bserve the mother for any
further bleeding
•p
lace a clean combine or
sanitary pad in place
Advanced First Aid
•d
o not remove ties once cord
has been cut. Observe closely
for haemorrhage at the cut
sites and control if present
•e
nsure all pads or products
from birth are retained and
sent with the mother to
hospital
•h
elp with clean clothing and/
or hygiene for the mother
•k
eep warm.
• s timulate breathing by
rubbing the baby’s back
• if no signs of life after 1
minute start CPR
•w
rap the baby in a blanket
and maintain body warmth
immediately
•n
ote time of delivery.
127
128
Techniques
TECHNIQUES
129
Techniques
Hand Washing
Hand washing is a very
important technique and is
one of the most basic ways to
prevent the spread of disease.
Good hand washing technique
is easy to learn and essential
when performing aseptic
dressing procedures:
•h
ave access to appropriate
hand washing facilities
• r emove any items of jewellery
worn on hands or wrists
• t urn on water and regulate to
appropriate temperature
•w
et your hands with warm
running water
•a
pply liquid soap from
dispenser (bar soap should
be avoided whenever
possible due to potential of
cross infection)
• r ub hands together, making
a soapy lather, wash the front
and back of hands, as well
as between your fingers and
under your nails. Work lather
over hands and wrists all the
way up to elbows. This must
be done for at least 1 minute
130
• if nail brush to be used it
must be single use brush
only and discarded after use
• r inse soap off thoroughly
using a single use disposable
hand towel
• t urn off tap by using hand
towel or back of elbow. Do
not turn off with bare hands
•d
iscard hand towel into foot
pedal operated bin.
Temperature
A temperature can be taken
with a thermometer. There are
several types of thermometers
available to take a temperature
with:
• digital
•g
lass with a bulb containing
mercury.
Taking a Temperature
•w
ash hands prior to
procedure
•e
xplain to casualty the
procedure you are about
to perform
• if using glass thermometer
shake mercury into base of
thermometer
• if using digital press “on”
button.
Underarm Method
•m
ake sure under arm is dry
•p
oint the thermometer
upward and place the tip well
into the casualty’s underarm
Techniques
•w
ipe the thermometer with
an alcohol wipe prior to use.
Digital thermometers also
come with a plastic probe
cover for hygiene purposes.
• f old casualty’s arm over
chest to hold in place and
keep air away from underarm
•k
eep in place for 4 minutes
• if using digital listen for beep
Oral Method
•p
lace thermometer bulb
(glass) or probe (digital)
under tongue, hold in place
with mouth closed
•k
eep in place for 2 minutes
• if using digital a beep will be
heard when ready
• r emove thermometer, read
temperature on display and
record result
•c
lean thermometer with
alcohol wipe and place back
into storage container.
• r emove thermometer, read
temperature on display and
record result
•c
lean thermometer with
alcohol wipe and place back
into storage container.
Eye Irrigation
The purpose of eye irrigation is
to dilute or remove chemicals
from the eye. It can also help
to relieve pain and burning
that can be associated with
a foreign body:
•e
xplain and reassure the
casualty
•w
ash your hands
• if possible, put on gloves
131
•p
osition the casualty for
comfort and easy access
to perform the procedure.
Ensure adequate lighting
•p
repare equipment required
(eye irrigation solution, towel
to protect casualty and
surrounds, bowl to catch fluid
from irrigation)
Aseptic dressing technique
is an important procedure
performed for the management
of chronic, acute and infected
wounds. It is important that the
procedure is undertaken in the
correct way to promote wound
healing and prevent infection:
•a
sk casualty to open both
eyes
• check for a care plan regarding
the wound and its treatment
• t aking care not to apply
direct pressure to the
eyeball, hold the lids open
on affected eye
•p
repare and protect the
appropriate working surfaces
with disinfectant solution
before commencing procedure
•d
irect a gentle and steady
flow of eye wash solution
from the inner aspect of
eye to outer aspect of eye.
Catch excess fluid in bowl
•a
ssemble necessary
equipment for procedure
– antiseptic soltuion, new
dressing and dressing pack
•e
ncourage the casualty to
move eye in all directions
• r e-examine eye after
irrigation procedure
• r epeat if unsuccessful
•e
nsure casualty is clean,
dry and comfortable after
procedure
•a
n eye patch may need to be
applied for further protection.
132
Dressing Technique
•p
lace disposable waste
bag within easy access of
working surface to discard
used dressing material in.
• prepare the wound for dressing.
Loosen dressing for easy
removal
•w
ash hands
•o
pen the outer cover of
dressing pack and remove
inner pack placing onto
prepared surface
•w
ith forceps used for
arranging items, remove
loosened dressing and
discard dressing and forceps
into rubbish bag
•o
pen appropriate dressings
required and place on sterile
dressing surface or pour
solutions that are required
into sterile dressing container
•w
ash hands using
appropriate technique
•p
ut on sterile gloves if
available
• if no gloves are available,
use the non touch technique
• s terile dressing towel
should now be placed
between wound and person
performing dressing to
maintain sterile dressing field
•u
sing dressing forceps pick
up and moisten swab with
solution in container
•c
lean wound by using one
swab at a time, swab from
outside of wound to within.
One swab for each stroke
Techniques
•w
ith the forceps which can
be viewed on outer surface
of pack open inner pack and
arrange contents
•o
nce wound has been
cleansed, dry wound and
cover with new sterile
dressing. Secure with tape
•a
ll used dressing items to be
placed onto used dressing
tray and wrapped up
•p
lace wrapped items into
waste bag. Waste bag is then
disposed of into medical
waste
•d
isinfect working surface
•w
ash hands thoroughly
•c
omplete any paper work
regarding procedure.
133
Taking a Pulse
A pulse represents the beating
of the heart.
Radial Pulse
This is the pulse that is taken
at your wrist. The radial pulse
may not be present if the
person is in shock. To take
the radial pulse:
• move your fingers along until
you can feel a slight pulsation
– this is the carotid pulse.
The pulse rate is the amount of
beats counted over one minute.
For example, a pulse may be
recorded as 70 beats per
minute.
Blood Pressure
•u
se 2 fingers, preferably
the 2nd and 3rd finger
•p
lace them in the groove in
the wrist that lies below the
thumb
•m
ove your fingers along until
you can feel a slight pulsation,
this is the radial pulse.
Carotid Pulse
This is the pulse felt in your
neck. The carotid pulse can
be more easily felt and is
sometimes stronger than the
radial pulse. A Carotid pulse
should be the preferred pulse
check site:
•u
se 2 fingers, preferably
the 2nd and 3rd finger
• place them along side the
outer edge of the trachea
(windpipe)
134
There are several types of
blood pressure machines
available to take a blood
pressure with:
•m
ercury sphygmomanometer
•a
neroid sphygmomanometer
• electronic device.
Preparing to take a
Blood Pressure
• the casualty should not smoke,
drink alcohol or coffee
approximately 15 minutes
prior to procedure
•a
rm should be supported
with a pillow
• r est before the procedure
•d
on’t talk during
measurement
• r emove any thick clothing
covering arm.
Blood Pressure by Palpation
•p
lace the cuff around the arm
leaving the cuff’s lower edge
about 2cm above the bend
of the elbow
•c
lose the cuff around the
arm using the velcro to
secure in place
•w
ith one hand locate the
brachial or radial pulse by
using 2 fingers (palpation)
•w
ith the other hand tighten
the screw at the side of the
rubber bulb
•b
y squeezing the bulb air is
pumped into the cuff which
causes it to expand
• inflate the cuff 30mmHg.
above the point where the
brachial or radial pulse
disappears
Techniques
•m
ake sure the casualty
is sitting in a comfortable
position with back supported
•o
pen the screw slowly whilst
feeling for the return of the
brachial or radial pulse
• look at sphygmomanometer
and note reading when pulse
returns
•c
ompletely deflate the cuff
and write down the reading
e.g., 120/P (P=Palpation).
Blood Pressure by
Stethoscope
A stethoscope is a device used
to listen for sound at various
locations around the body. The
part which comes in contact
with the body is known as the
bell. There are two ear pieces
connected by tubing at the
other end of the stethoscope.
•w
ith one hand place the bell
of the stethoscope over the
brachial artery
•w
ith the other hand tighten
the screw at the side of the
rubber bulb
135
•by squeezing the bulb air is
pumped into the cuff which
causes it to expand
• inflate the cuff 30mm Hg
above the point of the brachial
pulse sound disappearing
•p
lace the cuff around the
arm leaving the cuff’s lower
edge about 2cm above the
bend of the elbow
•o
pen the screw slowly whilst
listening for the return of the
brachial pulse
•c
lose the cuff around the
arm using the velcro to
secure in place
• look at sphygmomanometer
and note reading when the
sound of the pulse returns.
This is known as the systolic
pressure
• s witch on the machine
•c
ontinue to look at the
sphygmomanometer, note
reading when the sound of
the pulse disappears. This
is known as the diastolic
pressure
•c
ompletely deflate the cuff
and write down the reading:
e.g., 120/80.
136
Blood Pressure by
Electronic Devices
•n
umbers will display on
screen, once this has
occurred press the start
button
• t he machine will
automatically inflate and
deflate the cuff
• t he machine will display
results when complete
•R
ecord the reading:
e.g., 120/80.
Workbook
WORKBOOK
137
Workbook Questions
Introduction
1. What are the 4 aims of First Aid?
1.
2.
3.
4.
2. List 4 situations in which you may need to assist with First Aid?
1.
2.
3.
4.
3. You should provide First Aid until:
1.
2.
3.
4.
4.Does a conscious casualty need to give consent for a First Aider
to initiate care?
Yes
No
5.Do you need consent to initiate First Aid treatment to an
unconscious casualty?
Yes
No
Explain your answer
6.What are 2 recommended guidelines when preparing a First Aid
treatment report?
1.
2.
7. Why is it important for a First Aider to possess a First Aid kit?
138
9. H
ow should you dispose of used bandages?
Workbook
8.How can First Aiders protect themselves against exposure to a
casualty’s body fluids?
Human Anatomy
10. What is the heart’s role in the body?
11. What are the main parts of the respiratory system?
12. What is the function of the respiratory system?
13.What are 2 functions of the musculoskeletal system?
1.
2.
14. What is the function of the lymphatic system?
15. What is one of the main functions of the skin?
Emergency Action Plan
16. What does DRSABCD stand for?
17. Complete this sentence: Safety to you, bystanders and
18. List 2 reasons why you would move a casualty:
1.
2.
139
19.What is one of the main causes of an airway obstruction in an
unconscious casualty?
20. What is rescue breathing?
21.When performing CPR on an adult how many compressions are
recommended per minute?
22. Only stop CPR when:
23.What 2 numbers can be dialled to call emergency assistance from
a mobile telephone?
24.What information needs to be provided to emergency services
when calling for help?
25.What are 2 reasons why somebody would wear a ‘MedicAlert®
bracelet and or necklace’?
1.
2.
Airway Management
26. What are 2 techniques used to open an airway?
1.
2.
27.What are 3 actions to be taken when assessing whether or not
a casualty is breathing?
1.
2.
3.
140
29.What is the risk of leaving an unconscious casualty lying on
his/her back?
Workbook
28. If the casualty is not breathing normally, what should you do?
30.When placing an unconscious pregnant woman in a recovery
position, on which side should she be placed and why?
Cardiopulmonary Resuscitation
31. What are the 4 links of the ‘Chain Of Survival’?
1.
2.
3.
4.
32.When performing CPR on an adult, how many compressions are
needed for every 2 breaths?
33. List 3 reasons when CRP can be stopped:
1.
2.
3.
Assessing a casualty
34.The secondary assessment should only be performed on an
unconscious casualty?
True False
35. Where on the body does the secondary assessment begin?
36.When performing a secondary assessment on a casualty what are
you looking for when examining limbs?
141
Bleeding and Shock
37. What are the 2 types of haemorrhage?
38.What is involved in the management of an external haemorrhage
after the First Aider has checked DRSABCD?
39. A First Aider should remove an embedded object:
True False
40. Should an amputated body part be placed directly in ice?
True False
41.When pinching the nose to stop a nose bleed how long should you
apply pressure?
42.What are 5 signs and symptoms of Shock?
1.
2.
3.
4.
5.
Burns
43. What are the 3 classifications of burns?
1.
2.
3.
44. How long should you cool a burn with cool running water?
45. Should you remove a casualty’s clothing if it is adhered to the skin?
True False
46.If chemicals enter an eye, how long should you irrigate the eye and
what type of fluid can be used to irrigate?
142
47.If an unconscious casualty has discharge from the left ear, which ear
should be closer to the ground once placed in the recovery position?
48. Give one reason a helmet can be removed in an emergency.
Workbook
Trauma
49.List 5 signs and symptoms that may be evident when a casualty
fractures a rib.
1.
2.
3.
4.
5.
50.If there is a protruding object embedded in the chest, how should
you bandage the area?
51.What sort of dressing should be placed over an injury where
abdominal contents are exposed?
52.List 5 signs and symptoms of a fracture.
1.
2.
3.
4.
5.
53. Explain the difference between an open and closed fracture.
54.A fracture is _____________________________ to prevent the sharp
edges of the ___________________________________ from moving
and cutting tissue, muscle, blood vessels, and nerves.
55. W
hat is meant by the term ‘soft tissue’?
143
56. What is the treatment for a soft tissue injury?
R
I
C
E
Medical
57. Explain Syncope.
58. What are 3 common causes of Anaphylaxis?
1.
2.
3.
59.List 5 signs and symptoms that may indicate a person suffering
from Anaphylaxis.
1.
2.
3.
4.
5.
60.What is the device called that a person suffering from Anaphylaxis
may carry with them?
61. What colour is the Ventolin container?
62.What are 3 signs and symptoms of a person suffering from
Hyperventilation?
1.
2.
3.
63. Explain the term stroke.
144
65.What is the treatment for a conscious person who is pale and
sweaty and who is known to have diabetes?
Workbook
64. What are 2 signs of stroke?
1.
2.
66.Should the First Aider place something in the mouth of a person
who is having a seizure?
Yes
No
67. Why do Febrile Convulsions occur in some children?
68. List 5 signs and symptoms of a Heart Attack.
1.
2.
3.
4.
5.
69.In a choking person who is coughing effectively, is the treatment to
apply firm blows to the back?
Yes
No
70. What is the Poison Information Centre phone number?
71. Does a person who is suffering from heat stroke sweat?
Yes
No
Bites and Stings Envenomation
72. What is the main goal when treating a casualty for snake bite?
73.What is the treatment for a Red-Back Spider bite?
74.How is the barb removed from a bee sting?
75. What is the treatment for a tick bite?
145
146
Index
INDEX
147
A
abdominal injuries
67
adrenaline
78
AED
34
airway management
24
airway management (adult) 26
airway management (child) 26
airway management (infant) 26
airway obstruction
24
anaphylaxis
77
angina
91
ant sting
105
aseptic dressing technique132
assessing an accident scene 42
assessment, primary
42
assessment, secondary 43
asthma
79
Automated External Defibrillation
See AED
B
back care
See spine care
bee stings
105
basic life support flow chart
(DRSABCD)
21
bends, the
See DCS
behavioural emergencies118
bleeding
48
bleeding (external)
48
bleeding (internal)
52
blood pressure, taking
134
blue-ringed octopus sting
106
box jellyfish sting
108
148
breathing (adult)
breathing (child)
breathing (infant)
burns
burns (airway)
27
27
28
55
57
C
cardiac arrest
40
cardiopulmonary resuscitation
See CPR
cardiovascular system
12
Chain of Survival
41
chest injuries
65
chest pain
90
chest wound, penetrating 65
childbirth, emergency
125
choking
83
choking (adult, child)
84
choking (infant)
85
compressions, chest
(adult, child)
32
compressions, chest (infant) 32
cone-shell sting
107
CPR
36
crush injuries
68
D
DCS
decompression sickness
See DCS
defibrillation
diabetes
digestive system
diving emergencies
DRSABCD
115
33
87
14
115
18
E
ear, object in
ear, insect in
eardrum, ruptured
ECC
emergency action plan
See DRSABCD
endocrine system
EpiPen®
external chest compression
See ECC
eye injuries
eye irrigation
F
fainting
See syncope
febrile convulsion
first aid kits
first aid, definition
fish stings
fitting
See seizure
fractures
funnel web spider bite
21
100
94
59
60
60
32
14
77
61
131
86
6
3
109
69
104
G
getting help
(emergency services) 8
H
haemorrhage
See bleeding
hand washing technique
130
head injuries
58
head tilt technique
25
heart attack
91
heat exhaustion
96
heatstroke
97
helmet removal
64
Hudson face mask
119
hygiene, first aid
7
hyperglycaemia 88
hyperventilation 81
hypoglycaemia
87
hypothermia98
I
insect stings
J
jaw, fractured
jaw thrust technique
Index
DRSABCD, flow chart
drowning
drug overdose
105
70
25
L
labour (stages of)
125
legal considerations in first aid 4
limb, fractured
70
lung, ruptured
116
lymphatic system
14
M
machine accidents
medical alert devices
medical oxygen
medical oxygen regulators
mouth-to-mask
113
9
119
121
30
149
mouth-to-mouth 29
mouth-to-mouth-and-nose29
mouth-to-nose
29
mouth-to-stoma 30
musculoskeletal system 13
N
nebuliser mask device
nervous system
nose bleed
O
oral airways
oropharyngeal airways
See oral airways
oxygen administration
P
pelvis, fractured
pressure immobilisation
technique
poisoning
primary assessment
See assessment, primary
pulse, taking
120
11
51
secondary assessment
See assessment, secondary
shock
53
seizure (fitting)
89
skin, the
15
slings, types of
71
snake bites
102
soft bag and mask device120
soft tissue injuries
spider bites
122
119
73
103
spinal injuries
63
spine care
123
splints (fractures)
70
stroke
82
syncope (fainting)
76
70
T
temperature,
102
92
techniques of taking
130
the bends
See DCS
134
R
reassuring the casualty
10
recovery position
22
red-back spider bite
103
reproductive system
15
rescue breathing
29
respiratory system
13
R.I.C.E. (soft tissue injury) 73
road accidents
113
150
S
tick bite
tooth injuries
110
62
touch and talk technique 19
triage
112
U
unconscious casualty
22
urinary system
14
W
wasp stings
105
IN AN EMERGENCY CALL: 000
Remember: Any resuscitation is better than none at all.
AED = Automated External Defibrillator
Source: ARC Basic Life Support Flow Chart (2011)
Poisons Information Centre: 13 11 26
Registered Training Organisation National – Provider Code 40185 – CRICOS No. 03222F
Associate Member of the Australian Resuscitation Council (ARC)
300 2 4LIFE
4Life Phone: 1
1300 2 45433
Email: info@4lifetraining.com.au
Website: www.4lifetraining.com.au